Individual
DR. ELLIS LUCA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2711 E MADISON ST STE 204, SEATTLE, WA 98112-4763
(206) 984-3924
(206) 339-1776
Mailing address
2711 E MADISON ST STE 204, SEATTLE, WA 98112-4763
(206) 984-3924
(206) 339-1776
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD60937058
WA
2084P0804X
Child & Adolescent Psychiatry Physician
MD60937058
WA
Other
Enumeration date
05/11/2015
Last updated
03/11/2024
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