Active NPI
Gwyneth Leeanne Soboleff
- Mental Health Counselor
- Shelton, WA
National Provider Identifier
1972021384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 110 W K St
Shelton, WA 98584-2944 - Phone
- (360) 704-7170
- NPI assigned
- Sep 6, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
110 W K St
Shelton, WA 98584-2944
Mailing address
3857 Martin Way E
Olympia, WA 98506-5268
Phone (360) 704-7170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100567 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504656000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1504656000000",
"number": "1972021384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3857 MARTIN WAY E",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985065268",
"telephone_number": "360-704-7170"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 W K ST",
"city": "SHELTON",
"state": "WA",
"postal_code": "985842944",
"telephone_number": "360-704-7170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOBOLEFF",
"first_name": "GWYNETH",
"middle_name": "LEEANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-06",
"last_updated": "2017-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100567",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.