Provider Demographics
NPI:1760758197
Name:SOTO, JASON ARTHUR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ARTHUR
Last Name:SOTO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MAIN
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8904
Mailing Address - Country:US
Mailing Address - Phone:253-304-4522
Mailing Address - Fax:
Practice Address - Street 1:104 W MAIN
Practice Address - Street 2:SUITE 207
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8904
Practice Address - Country:US
Practice Address - Phone:253-304-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LF 60232789106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist