Provider Demographics
NPI:1598314320
Name:JARVI, KERRY
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:JARVI
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 1:19655 1ST AVE S STE 206
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-2172
Mailing Address - Country:US
Mailing Address - Phone:425-835-2180
Mailing Address - Fax:
Practice Address - Street 1:19655 1ST AVE S STE 206
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-2172
Practice Address - Country:US
Practice Address - Phone:425-835-2180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMC61103890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor