Provider Demographics
NPI:1255483715
Name:LITMAN, JACK MYRON (PHD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:MYRON
Last Name:LITMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 NE 41ST ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6791
Mailing Address - Country:US
Mailing Address - Phone:360-253-6425
Mailing Address - Fax:360-253-3196
Practice Address - Street 1:7600 NE 41ST ST
Practice Address - Street 2:SUITE 310
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6791
Practice Address - Country:US
Practice Address - Phone:360-253-6425
Practice Address - Fax:360-253-3196
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA958103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical