Active NPI
Matthew Todd Leibsohn, PH.D.
- Counseling Psychologist
- Bellevue, WA
National Provider Identifier
1972791358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 1764
- Practice address
- 1450 114TH Ave SE
Ste 100
Bellevue, WA 98004-6962 - Phone
- (425) 453-7722
- Fax
- (425) 320-1021
- NPI assigned
- Oct 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 1764 | WA | Primary |
Addresses
Primary practice location
1450 114TH Ave SE
Ste 100
Bellevue, WA 98004-6962
Mailing address
3206 74TH PL SE
Mercer Island, WA 98040-3400
Phone (425) 453-7722
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1764 | WA | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191974400000",
"number": "1972791358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3206 74TH PL SE",
"city": "MERCER ISLAND",
"state": "WA",
"postal_code": "980403400",
"telephone_number": "425-453-7722",
"fax_number": "425-320-1021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 114TH AVE SE",
"address_2": "STE 100",
"city": "BELLEVUE",
"state": "WA",
"postal_code": "980046962",
"telephone_number": "425-453-7722",
"fax_number": "425-320-1021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIBSOHN",
"first_name": "MATTHEW",
"middle_name": "TODD",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-10",
"last_updated": "2007-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WA",
"license": "1764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellevue, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.