Provider Demographics
NPI:1033678610
Name:SINCLAIR, KALEB D (MA, LMCHA)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:D
Last Name:SINCLAIR
Suffix:
Gender:M
Credentials:MA, LMCHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11335 NE 122ND WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6933
Mailing Address - Country:US
Mailing Address - Phone:206-614-0057
Mailing Address - Fax:206-614-0047
Practice Address - Street 1:11335 NE 122ND WAY STE 105
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6933
Practice Address - Country:US
Practice Address - Phone:206-614-0057
Practice Address - Fax:206-614-0047
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 106S00000X
WA61249958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA111524501Medicaid