Provider Demographics
NPI:1629351499
Name:MACLEOD, JASON (LMHC, CDP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MACLEOD
Suffix:
Gender:M
Credentials:LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21907 64TH AVE W
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2200
Mailing Address - Country:US
Mailing Address - Phone:425-418-0720
Mailing Address - Fax:
Practice Address - Street 1:21907 64TH AVE W
Practice Address - Street 2:SUITE 220
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2200
Practice Address - Country:US
Practice Address - Phone:425-418-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60145134101YA0400X
WALH60210365101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)