Provider Demographics
NPI:1477702587
Name:JUHL, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:JUHL
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 1:1210 S 72ND AVE
Mailing Address - Street 2:E47
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1994
Mailing Address - Country:US
Mailing Address - Phone:509-380-9618
Mailing Address - Fax:
Practice Address - Street 1:1210 S 72ND AVE
Practice Address - Street 2:E47
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1994
Practice Address - Country:US
Practice Address - Phone:509-380-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60048112101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor