Healthcare Provider Details

I. General information

NPI: 1679142970
Provider Name (Legal Business Name): ANGELINE BLATTENBAUER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15811 AMBAUM BLVD SW STE 110
BURIEN WA
98166-3071
US

IV. Provider business mailing address

15811 AMBAUM BLVD SW STE 110
BURIEN WA
98166-3071
US

V. Phone/Fax

Practice location:
  • Phone: 206-242-8211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61629880
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: