Provider Demographics
NPI:1740782804
Name:CARMICHAEL, JERRY KURT (LMHC)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:KURT
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16150 NE 85TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3542
Mailing Address - Country:US
Mailing Address - Phone:425-868-5777
Mailing Address - Fax:425-903-3957
Practice Address - Street 1:16150 NE 85TH ST STE 121
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3542
Practice Address - Country:US
Practice Address - Phone:425-868-5777
Practice Address - Fax:425-903-3957
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60822804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health