MEDICARE: THE MENTAL WELLNESS LOUNGE, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1962357228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MENTAL WELLNESS LOUNGE, PLLC

Provider Business Mailing Address
First Line	:	9030 35TH AVE SW STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9030 35TH AVE SW STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3821
Country	:	US
Telephone Number	:	206-786-4297
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KANDYCE OUTLAW
Credential	:
Telephone Number	:	206-786-4297

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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