Provider Demographics
NPI:1922619386
Name:POWELL, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:POWELL
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 1:18537 1ST AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1867
Mailing Address - Country:US
Mailing Address - Phone:425-390-4677
Mailing Address - Fax:
Practice Address - Street 1:18537 1ST AVE S STE B
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-1867
Practice Address - Country:US
Practice Address - Phone:425-390-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health