Healthcare Provider Details

I. General information

NPI: 1558249623
Provider Name (Legal Business Name): MOSES L MSUMBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 NE 122ND WAY STE 100
KIRKLAND WA
98034-6927
US

IV. Provider business mailing address

12433 ADMIRALTY WAY APT D202
EVERETT WA
98204-8039
US

V. Phone/Fax

Practice location:
  • Phone: 425-650-4005
  • Fax:
Mailing address:
  • Phone: 253-329-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: