Healthcare Provider Details

I. General information

NPI: 1528929775
Provider Name (Legal Business Name): KYLE TAKACS LMFTA, LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 FRONT ST N STE A
ISSAQUAH WA
98027-2965
US

IV. Provider business mailing address

2824 233RD PL NE
SAMMAMISH WA
98074-5430
US

V. Phone/Fax

Practice location:
  • Phone: 425-652-1690
  • Fax:
Mailing address:
  • Phone: 425-223-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61564735
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61564734
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: