Provider Demographics
NPI:1225809627
Name:CASE, JAYSON LEE
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:LEE
Last Name:CASE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WHITNEY BLVD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-9680
Mailing Address - Country:US
Mailing Address - Phone:360-559-3021
Mailing Address - Fax:
Practice Address - Street 1:20311 OLD HIGHWAY 9 SW
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9620
Practice Address - Country:US
Practice Address - Phone:360-664-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health