| Puget Sound Psychotherapy, Ps | |
|
2719 E Madison St Ste 300 Seattle WA 98112-4752 | |
| (206) 669-4336 | |
| (206) 279-7009 |
| Full Name | Puget Sound Psychotherapy, Ps |
|---|---|
| Speciality | Counselor |
| Location | 2719 E Madison St Ste 300, Seattle, Washington |
| Authorized Official Name and Position | Evonne Noble (OWNER) |
| Authorized Official Contact | 2066694336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Puget Sound Psychotherapy, Ps 2719 E Madison St Ste 300 Seattle WA 98112-4752 Ph: (206) 669-4336 | Puget Sound Psychotherapy, Ps 2719 E Madison St Ste 300 Seattle WA 98112-4752 Ph: (206) 669-4336 |
| NPI Number | 1912310103 |
|---|---|
| Provider Enumeration Date | 06/05/2014 |
| Last Update Date | 11/21/2024 |
| Certification Date | 11/21/2024 |
| Medicare PECOS PAC ID | 6901332691 |
|---|---|
| Medicare Enrollment ID | O20241204003183 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912310103 | NPI | - | NPPES |
| Provider Name | Charles Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194169367 PECOS PAC ID: 8729309349 Enrollment ID: I20150609000231 |
| Provider Name | Geoffrey H Fong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376885590 PECOS PAC ID: 8123266194 Enrollment ID: I20201202002146 |
| Provider Name | Evonne Noble |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1841604592 PECOS PAC ID: 8628504313 Enrollment ID: I20241204003535 |
| Provider Name | Barbara Josephine Gorham |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1891202834 PECOS PAC ID: 0941736060 Enrollment ID: I20241211004464 |
| Provider Name | Alexandra R Contrades |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063066405 PECOS PAC ID: 8426584590 Enrollment ID: I20241212001736 |
| Provider Name | Molly Cvetovac |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144798653 PECOS PAC ID: 1355877457 Enrollment ID: I20241212003201 |
| Provider Name | Andrea Davis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1225308455 PECOS PAC ID: 0244766228 Enrollment ID: I20241213002572 |
| Provider Name | Gabriel Salvador Gomez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629407713 PECOS PAC ID: 3870020258 Enrollment ID: I20241224001161 |
| Provider Name | Timothy D Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669182747 PECOS PAC ID: 9234667015 Enrollment ID: I20250107002117 |
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