Healthcare Provider Details

I. General information

NPI: 1992600282
Provider Name (Legal Business Name): LUNA SOUL PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25510 223RD CT SE
MAPLE VALLEY WA
98038-6034
US

IV. Provider business mailing address

25510 223RD CT SE
MAPLE VALLEY WA
98038-6034
US

V. Phone/Fax

Practice location:
  • Phone: 253-508-3777
  • Fax:
Mailing address:
  • Phone: 253-508-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: EMILY ALTOBELLI
Title or Position: OWNER
Credential: LMHCA
Phone: 253-508-3777