Provider Demographics
NPI:1710471214
Name:CHUG, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CHUG
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 1:13451 SE 36TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1454
Mailing Address - Country:US
Mailing Address - Phone:425-562-1337
Mailing Address - Fax:425-562-1331
Practice Address - Street 1:13451 SE 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1475
Practice Address - Country:US
Practice Address - Phone:425-562-1337
Practice Address - Fax:425-562-1331
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61375515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health