MEDICARE: COURTNEY SAN MIGUEL LMHC

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	101Y00000X	Counselor	LH61018018	WA

General Provider Information

NPI Number	:	1639886377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY SAN MIGUEL LMHC

Provider Business Mailing Address
First Line	:	7300 27TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-5933
Country	:	US
Telephone Number	:	206-519-7117
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 BURKE AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-8338
Country	:	US
Telephone Number	:	206-519-7117
Fax Number	:

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

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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Directions to “ COURTNEY SAN MIGUEL LMHC” Practice Location

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