Individual provider Active NPI

Rachaud Leon Smith, PSY.D.

  • Clinical Psychologist
  • Redmond, WA
National Provider Identifier
1154569879
Registry record updated Feb 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY60045049 Issued in WA
Practice address
15436 Bel Red Rd
Ste 100
Redmond, WA 98052-5536
Phone
(425) 644-4100
Fax
(425) 644-4101
NPI assigned
Feb 3, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY60045049 WA Primary

Addresses

Primary practice location

15436 Bel Red Rd
Ste 100
Redmond, WA 98052-5536

Mailing address

15436 Bel Red Rd
Ste 100
Redmond, WA 98052-5536
Phone (425) 644-4100

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
I20110527000112 WA Practitioner - Clinical Psychologist 7315124468 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindful Therapy Group PCGroup PAC ID 4981872561, 654 clinicians

Practice addresses (Care Compare)

7100 Fort Dent Way
Suite 220
Tukwila, WA 98188-8553
Phone (425) 640-7009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PY60045049WAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mindful Therapy Group PC CurrentSince Jul 3, 2018 Accepting new patients

Locations

6505 216th St SW
Ste 100
Mountlake Terrace, WA 98043
Phone (425) 678-6463

21907 64th Ave W
Ste 200
Mountlake Terrace, WA 98043
Phone (410) 258-3698

320 NE 97th St
Ste A
Seattle, WA 98115
Phone (206) 323-8113

7100 Fort Dent Way
Ste 220
Tukwila, WA 98188
Phone (206) 708-7274

Organizations & group practices 1

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": "1233619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233619200000",
    "number": "1154569879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15436 BEL RED RD",
            "address_2": "STE 100",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980525536",
            "telephone_number": "425-644-4100",
            "fax_number": "425-644-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15436 BEL RED RD",
            "address_2": "STE 100",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980525536",
            "telephone_number": "425-644-4100",
            "fax_number": "425-644-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "RACHAUD",
        "middle_name": "LEON",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-03",
        "last_updated": "2009-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY60045049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redmond, WA

Sources for this page

Verify at the official NPI Registry.