Provider Demographics
NPI:1467055947
Name:ST. JACQUES, CHRISTIAN (LMHCA (MC 61093652))
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:ST. JACQUES
Suffix:
Gender:M
Credentials:LMHCA (MC 61093652)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11441 81ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3558
Mailing Address - Country:US
Mailing Address - Phone:206-351-3811
Mailing Address - Fax:
Practice Address - Street 1:4030 LAKE WASHINGTON BLVD NE STE 201
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7870
Practice Address - Country:US
Practice Address - Phone:206-590-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61093652101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health