Provider Demographics
NPI:1295414050
Name:JZYK, NICHOLAS G (MD LMHCA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:G
Last Name:JZYK
Suffix:
Gender:M
Credentials:MD LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 NW 201ST ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2352
Mailing Address - Country:US
Mailing Address - Phone:206-883-4910
Mailing Address - Fax:
Practice Address - Street 1:2173 NW 201ST ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-2352
Practice Address - Country:US
Practice Address - Phone:206-883-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61447480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health