Healthcare Provider Details

I. General information

NPI: 1750195038
Provider Name (Legal Business Name): SAMUEL PETER JAMES NOBLE LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 LAKE WASHINGTON BLVD NE STE 201
KIRKLAND WA
98033-7870
US

IV. Provider business mailing address

1134 17TH AVE APT 202
SEATTLE WA
98122-4618
US

V. Phone/Fax

Practice location:
  • Phone: 206-414-8918
  • Fax:
Mailing address:
  • Phone: 310-683-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61614668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: