Provider Demographics
NPI:1598386021
Name:YOUNGQUIST, TREVOR SHAWN (MA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:SHAWN
Last Name:YOUNGQUIST
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 NE 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2712
Mailing Address - Country:US
Mailing Address - Phone:360-298-4490
Mailing Address - Fax:
Practice Address - Street 1:127 NE 58TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2712
Practice Address - Country:US
Practice Address - Phone:360-298-4490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WAMC61085665101YM0800X
WALH61254033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor