MEDICARE: DR. ANTOINE LEBEAUT PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY61620552	WA

General Provider Information

NPI Number	:	1053093526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTOINE LEBEAUT PHD

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:	206-520-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 ROOSEVELT WAY NE FL 3
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-6099
Country	:	US
Telephone Number	:	206-598-7792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	06/04/2026

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