Healthcare Provider Details

I. General information

NPI: 1053093526
Provider Name (Legal Business Name): ANTOINE LEBEAUT PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2499
US

IV. Provider business mailing address

4225 ROOSEVELT WAY NE FL 3
SEATTLE WA
98105-6099
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61620552
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: