Individual provider Active NPI

Miu Ezra Hart, LMHC, SUDPT

  • Psychologist
  • Seattle, WA
National Provider Identifier
1053897017
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSYC.PY.61607301 Issued in WA
Practice address
1116 Summit Ave
Seattle, WA 98101-2831
Phone
(425) 558-0558
NPI assigned
Jul 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 29, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSYC.PY.61607301 WA Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X CO61470827 WA
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

1116 Summit Ave
Seattle, WA 98101-2831

Mailing address

1116 Summit Ave
Seattle, WA 98101-2831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251216003151 WA Practitioner - Clinical Psychologist 5092200188 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Health ServicesGroup PAC ID 4284891052, 10 clinicians

Practice addresses (Care Compare)

1901 Martin Luther King Jr Way S
Seattle, WA 98144-4801
Phone (206) 322-7676

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CO61470827WAMDAddiction (Substance Use Disorder) Counselor
PSYC.PY.61607301WAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Health Services Addiction (Substance Use Disorder) CurrentSince Oct 4, 2025 Accepting new patients
Sandbox Therapy Group, Inc. Mental Health PastSince Aug 28, 2022 Accepting new patients

Locations

1901 Mlk Jr Way S
Seattle, WA 98144
Phone (206) 322-7676

1116 Summit Ave
Seattle, WA 98101
Phone (206) 323-0930

5802 Rainier Ave S
Seattle, WA 98118
Phone (206) 723-1980

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780012800000",
    "number": "1053897017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1116 SUMMIT AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 SUMMIT AVE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981012831",
            "telephone_number": "425-558-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART",
        "first_name": "MIU",
        "middle_name": "EZRA",
        "name_prefix": "Dr.",
        "credential": "LMHC, SUDPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PSYC.PY.61607301",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61470827",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.