Provider Demographics
NPI:1740751668
Name:YOURGLICH, JAY (BA, CDP)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:YOURGLICH
Suffix:
Gender:M
Credentials:BA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 S 23RD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1615
Mailing Address - Country:US
Mailing Address - Phone:253-272-2242
Mailing Address - Fax:253-272-0171
Practice Address - Street 1:3315 S 23RD ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1615
Practice Address - Country:US
Practice Address - Phone:253-272-2242
Practice Address - Fax:253-272-0171
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60068240101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)