Provider Demographics
NPI:1518137355
Name:BURNS, JASON T (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:T
Last Name:BURNS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 COLUMBIA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4311
Mailing Address - Country:US
Mailing Address - Phone:360-653-0374
Mailing Address - Fax:
Practice Address - Street 1:1106 COLUMBIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4311
Practice Address - Country:US
Practice Address - Phone:360-653-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60392527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH60392527OtherDEPARTMENT OF HEALTH