Provider Demographics
NPI:1417150491
Name:WILLIAMSON, JAY C (MA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13606 NE 20TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2011
Mailing Address - Country:US
Mailing Address - Phone:425-643-2383
Mailing Address - Fax:425-795-7143
Practice Address - Street 1:13606 NE 20TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2011
Practice Address - Country:US
Practice Address - Phone:425-643-2383
Practice Address - Fax:425-795-7143
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005269101YM0800X
WALF00001189106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAWI3773OtherPIN