Individual provider Active NPI

Martin Eugene Knutson, LMHC

  • Mental Health Counselor
  • Bellevue, WA
National Provider Identifier
1275680936
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
LH00011002 Issued in WA
Practice address
2122 112TH Ave NE Ste B200
Bellevue, WA 98004-2973
Phone
(425) 869-2644
Fax
(425) 867-0930
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LH00011002 WA Primary

Addresses

Primary practice location

2122 112TH Ave NE Ste B200
Bellevue, WA 98004-2973

Mailing address

8275 166TH Ave NE Ste 200
Redmond, WA 98052-6629
Phone (425) 869-2644

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
I20240106000378 WA Practitioner - Mental Health Counselor 4082065768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emmaus Counseling Service PSGroup PAC ID 5193726701, 21 clinicians

Practice addresses (Care Compare)

2122 112TH Ave NE
Suite B200
Bellevue, WA 98004-2973
Phone (425) 869-2644

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LH00011002WAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Emmaus Counseling Service PS Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

2122 112th Ave NE
Ste B200
Bellevue, WA 98004

8275 166th Ave NE
Ste 200
Redmond, WA 98052
Phone 4258692644 ext. 17

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": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1275680936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8275 166TH AVE NE STE 200",
            "city": "REDMOND",
            "state": "WA",
            "postal_code": "980526629",
            "telephone_number": "425-869-2644",
            "fax_number": "425-867-0930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2122 112TH AVE NE STE B200",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042973",
            "telephone_number": "425-869-2644",
            "fax_number": "425-867-0930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNUTSON",
        "first_name": "MARTIN",
        "middle_name": "EUGENE",
        "name_prefix": "Mr.",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LH00011002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

Verify at the official NPI Registry.