Provider Demographics
NPI:1275804783
Name:LATHROP-WEBER, JARRED (LMHCA, MHP)
Entity Type:Individual
Prefix:
First Name:JARRED
Middle Name:
Last Name:LATHROP-WEBER
Suffix:
Gender:M
Credentials:LMHCA, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 E MADISON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2876
Mailing Address - Country:US
Mailing Address - Phone:253-906-8738
Mailing Address - Fax:
Practice Address - Street 1:9001 46TH AVE S UNIT B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-5001
Practice Address - Country:US
Practice Address - Phone:253-906-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60166564103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling