Provider Demographics
NPI:1467793240
Name:NACANAYNAY, JESUS MARIA (MA MHP)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:MARIA
Last Name:NACANAYNAY
Suffix:
Gender:M
Credentials:MA MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23605 112TH AVE SE
Mailing Address - Street 2:B104
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3533
Mailing Address - Country:US
Mailing Address - Phone:253-520-1571
Mailing Address - Fax:
Practice Address - Street 1:23605 112TH AVE SE
Practice Address - Street 2:B104
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3533
Practice Address - Country:US
Practice Address - Phone:253-520-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60155223101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program