Provider Demographics
NPI:1750753513
Name:ELLE'S ESSENTIAL MASSAGE
Entity type:Organization
Organization Name:ELLE'S ESSENTIAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:CMT, LMP
Authorized Official - Phone:360-425-1826
Mailing Address - Street 1:803 VANDERCOOK WAY
Mailing Address - Street 2:STE 2
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4057
Mailing Address - Country:US
Mailing Address - Phone:360-425-1826
Mailing Address - Fax:
Practice Address - Street 1:803 VANDERCOOK WAY
Practice Address - Street 2:STE 2
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4057
Practice Address - Country:US
Practice Address - Phone:360-425-1826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603544296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty