Provider Demographics
NPI:1366871592
Name:LABASS, ERIC (PSYD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:LABASS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 9TH AVE NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4737
Mailing Address - Country:US
Mailing Address - Phone:206-453-1608
Mailing Address - Fax:206-829-2401
Practice Address - Street 1:4500 9TH AVE NE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4737
Practice Address - Country:US
Practice Address - Phone:206-453-1608
Practice Address - Fax:206-829-2401
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60278877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health