Provider Demographics
NPI:1336459676
Name:WILLIAMS-HAUPT, JARRETT KYLE
Entity Type:Individual
Prefix:
First Name:JARRETT
Middle Name:KYLE
Last Name:WILLIAMS-HAUPT
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 1:1717 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2059
Mailing Address - Country:US
Mailing Address - Phone:775-378-3507
Mailing Address - Fax:
Practice Address - Street 1:552 N COLORADO ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7779
Practice Address - Country:US
Practice Address - Phone:808-284-7225
Practice Address - Fax:858-521-8173
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst