Provider Demographics
NPI:1114477189
Name:GAVIN, JAMIE EDWIN (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:EDWIN
Last Name:GAVIN
Suffix:
Gender:M
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 H ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4100
Mailing Address - Country:US
Mailing Address - Phone:509-386-6524
Mailing Address - Fax:
Practice Address - Street 1:399 H ST STE 5
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-4100
Practice Address - Country:US
Practice Address - Phone:509-386-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WALH00004520101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)