MEDICARE: SKYLAR O LENNON LMHC, SUDP

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CP61184413	WA
2	101YM0800X	Mental Health Counselor	LH61513090	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588288658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR O LENNON LMHC, SUDP

Provider Business Mailing Address
First Line	:	1942 WESTLAKE AVE APT 3111
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1283
Country	:	US
Telephone Number	:	509-218-9810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1942 WESTLAKE AVE APT 3111
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1283
Country	:	US
Telephone Number	:	509-720-0439
Fax Number	:

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

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	10/18/2025

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