Provider Demographics
NPI:1467841460
Name:KEATTS, JAMELYN (MA)
Entity Type:Individual
Prefix:
First Name:JAMELYN
Middle Name:
Last Name:KEATTS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 EASTLAKE AVE E STE 220
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3012
Mailing Address - Country:US
Mailing Address - Phone:408-836-2896
Mailing Address - Fax:
Practice Address - Street 1:2900 EASTLAKE AVE E STE 220
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3012
Practice Address - Country:US
Practice Address - Phone:408-836-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60498732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health