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Deactivated NPI 1457823411 Deactivated / Inactive NPI Male Practitioner

Ethan Jon Blackstone , MFTA

Counselor • Bellevue, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Ethan Blackstone has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date December 31, 2018
NPI Deactivation Date September 30, 2020
Total Practice Duration ~2 Years of Practice (2018 – 2020)

Professional Overview & Biography Verified Profile Summary

Ethan Blackstone, MFTA was a registered Counselor practicing in Bellevue, WA. Throughout an active medical career spanning 2 years, Ethan Blackstone provided care at the practice location at 14216 NE 21ST ST until profile deactivation on 2020-09-30.

Practice Location & Contact Primary Location

Practice Address

14216 Ne 21st St

Bellevue, WA 980073720

Telephone 4256535000
Associated Practice Facility / Clinic
🏢 Sound Facility NPI 1780774950

Specialty Benchmarks & Practice Insights

Comparative analytics for Counselor in Bellevue, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 6.0 Yrs
State Avg: 13.0 Yrs
Regional Practice Density
263 Specialists

Practicing in Bellevue, WA (11556 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2020-10-13
Counselor Primary Specialty

NUCC Taxonomy Code: 101Y00000X

A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.

Student in an Organized Health Care Education/Training Program

NUCC Taxonomy Code: 390200000X

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Jennifer Beckwith , RC

Student in an Organized Health Care Education/Training Program

NPI 1003075896
Lara Maxwell , RC

Counselor - Professional

NPI 1013064617
Molly Filer

Student in an Organized Health Care Education/Training Program

NPI 1043731755
NPI 1043738578
Jana Laslo , RC

Student in an Organized Health Care Education/Training Program

NPI 1053570994
Cynthia Aldinger , BA, AAC

Counselor - Mental Health

NPI 1063569218

Bachelor of Arts, AAC

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events
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Provider Name / Credentials Updated October 13, 2020

Recorded as ETHAN BLACKSTONE, MFTA

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 13, 2020

Counselor

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NPI Profile Reactivated October 09, 2020

Record officially reactivated for active practice on October 09, 2020

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NPI Profile Deactivated September 30, 2020

Record deactivated on September 30, 2020

NPI Profile Active December 31, 2018

NPI status registered as active in NPPES database

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Updated Practice Location December 31, 2018

Registered at 14216 NE 21ST ST, BELLEVUE, WA 980073720 (Tel: 4256535000)

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Updated Business Mailing Address December 31, 2018

Registered at 6400 SOUTHCENTER BLVD, TUKWILA, WA 981882547

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Provider Name / Credentials Updated December 31, 2018

Recorded as ETHAN BLACKSTONE

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 31, 2018

Student in an Organized Health Care Education/Training Program

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Initial NPI Registration & Enumeration December 31, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1457823411
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 31, 2018
Last Update: October 13, 2020
Deactivation Date: September 30, 2020
Sole Proprietor: No

Mailing Address

6400 Southcenter Blvd

Tukwila, WA 981882547

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.