Provider Demographics
NPI: | 1518410430 |
---|---|
Name: | MCALLISTER, JASON EDWARD (BA, MA, LMHCA) |
Entity Type: | Individual |
Prefix: | |
First Name: | JASON |
Middle Name: | EDWARD |
Last Name: | MCALLISTER |
Suffix: | |
Gender: | M |
Credentials: | BA, MA, LMHCA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 8817 E. MISSION AVE |
Mailing Address - Street 2: | SUITE 106 |
Mailing Address - City: | SPOKANE VALLEY |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 99212 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 509-844-5947 |
Mailing Address - Fax: | 509-954-3343 |
Practice Address - Street 1: | 8817 E. MISSION AVE |
Practice Address - Street 2: | SUITE 106 |
Practice Address - City: | SPOKANE VALLEY |
Practice Address - State: | WA |
Practice Address - Zip Code: | 99212 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-844-5947 |
Practice Address - Fax: | 509-954-3343 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-07-27 |
Last Update Date: | 2020-12-02 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | CG60677305 | 101Y00000X |
WA | 60827194 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 2161142 | Medicaid |