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NPI Code Detail

MEDICARE: AIDAN BLACK MA

MEDICARE: AIDAN BLACK MA
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
1101YM0800XMental Health CounselorMHCA.MC.70132956WA
2101YP2500XProfessional CounselorMHCA.MC.70132956WA

General Provider Information

NPI Number : 1427980515
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIDAN BLACK MA
Provider Business Mailing Address
First Line : 622 S 320TH ST STE A
Second Line :
City : FEDERAL WAY
State : WA
Zip : 98003-4895
Country : US
Telephone Number : 360-306-0682
Fax Number :
Provider Business Practice Location Address
First Line : 201 160TH ST S STE 101
Second Line :
City : SPANAWAY
State : WA
Zip : 98387-8508
Country : US
Telephone Number : 253-904-6038
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2026
Last Update Date : 06/02/2026

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Directions to “ AIDAN BLACK MA” Practice Location

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