Provider Demographics
NPI:1275921603
Name:ULLRICH, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ULLRICH
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 1:448 NE RAVENNA BLVD
Mailing Address - Street 2:APT 101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-8420
Mailing Address - Country:US
Mailing Address - Phone:847-293-1132
Mailing Address - Fax:
Practice Address - Street 1:448 NE RAVENNA BLVD
Practice Address - Street 2:APT 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8420
Practice Address - Country:US
Practice Address - Phone:847-293-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60404032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional