Provider Demographics
NPI:1629328596
Name:BAILEY, JASON CHRISTOPHER (MA, LMHC, NCC, SOTP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MA, LMHC, NCC, SOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 102ND AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3466
Mailing Address - Country:US
Mailing Address - Phone:360-961-0388
Mailing Address - Fax:
Practice Address - Street 1:18221 102ND AVE NE STE C
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3466
Practice Address - Country:US
Practice Address - Phone:360-961-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALH60804736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health