=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619422102
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALETHEIA THERAPEUTICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2016
-----------------------------------------------------
Last Update Date | 02/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 BOREN AVE SUITE 701
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-3595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-473-2435
-----------------------------------------------------
Fax | 206-832-4641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 BOREN AVE SUITE 701
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-3595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-473-2435
-----------------------------------------------------
Fax | 206-832-4641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL JOHN SIBRAVA
-----------------------------------------------------
Credential | LMHC, NCC
-----------------------------------------------------
Telephone | 206-473-2435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------