Provider Demographics
NPI:1508163361
Name:WIRTH, JEFFREY MICHAEL
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:WIRTH
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 1:325 S UNIVERSITY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6164
Mailing Address - Country:US
Mailing Address - Phone:509-434-9128
Mailing Address - Fax:
Practice Address - Street 1:325 S UNIVERSITY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6164
Practice Address - Country:US
Practice Address - Phone:509-434-9128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor