NPIMap

Organization Active NPI

Puget Sound Psychotherapy, PS

  • Mental Health Counselor
  • Seattle, WA
National Provider Identifier
1912310103
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PUGET SOUND PSYCHOTHERAPY, PS
Practice address
2719 E Madison St Ste 300
Seattle, WA 98112-4752
Phone
(206) 669-4336
Fax
(206) 279-7009
NPI assigned
Jun 5, 2014
Last updated
Nov 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Evonne NobleNPI 1841604592
Title
Owner
Phone
(206) 669-4336

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

2719 E Madison St Ste 300
Seattle, WA 98112-4752

Mailing address

2719 E Madison St Ste 300
Seattle, WA 98112-4752
Phone (206) 669-4336

Other names 1

  • Puget Sound Psychotherapy, Inc Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241204003183 WA Part B Supplier - Clinic/Group Practice 6901332691 Receives reassigned benefits from 12 practitioners
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

Locations

3123 Fairview Ave E
Ste W
Seattle, WA 98102

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1401926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1912310103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2719 E MADISON ST STE 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124752",
            "telephone_number": "206-669-4336",
            "fax_number": "206-279-7009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2719 E MADISON ST STE 300",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124752",
            "telephone_number": "206-669-4336",
            "fax_number": "206-279-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND PSYCHOTHERAPY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-05",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A",
        "authorized_official_last_name": "NOBLE",
        "authorized_official_first_name": "EVONNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-669-4336"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puget Sound Psychotherapy, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.