Provider Demographics
NPI:1497026355
Name:AYRES, JEREMY STEVEN (MHCA, CDPT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:STEVEN
Last Name:AYRES
Suffix:
Gender:M
Credentials:MHCA, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:14270 NE 21ST ST
Practice Address - Street 2:SOUND MENTAL HEALTH
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3720
Practice Address - Country:US
Practice Address - Phone:425-653-5000
Practice Address - Fax:425-653-5010
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60319918101YM0800X, 101Y00000X
WACO60344511390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program