Provider Demographics
NPI:1407331028
Name:ROBLES, SERENA LAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:LAN
Last Name:ROBLES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 LAKE WASHINGTON BLVD NE STE 303
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7870
Mailing Address - Country:US
Mailing Address - Phone:425-276-2486
Mailing Address - Fax:
Practice Address - Street 1:4030 LAKE WASHINGTON BLVD NE STE 303
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7870
Practice Address - Country:US
Practice Address - Phone:425-276-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-28
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60691334101YM0800X
WALH61125304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1407331028OtherEXISTING NPI