Provider Demographics
NPI:1639705197
Name:MAIN, JEDIAH A (MS, NCC, LMHC)
Entity Type:Individual
Prefix:
First Name:JEDIAH
Middle Name:A
Last Name:MAIN
Suffix:
Gender:M
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:
Practice Address - Street 1:9708 N NEVADA ST STE 205
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-6012
Practice Address - Country:US
Practice Address - Phone:509-466-0226
Practice Address - Fax:844-273-3042
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61456151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health