Provider Demographics
NPI:1174825558
Name:CARSTAIRS, JERILYN JO (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:JO
Last Name:CARSTAIRS
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13018 SW COVE RD
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-3752
Mailing Address - Country:US
Mailing Address - Phone:206-567-4667
Mailing Address - Fax:
Practice Address - Street 1:13018 SW COVE RD
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-3752
Practice Address - Country:US
Practice Address - Phone:206-567-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 00001068106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist