Provider Demographics
NPI:1356715338
Name:ATKINSON, JEFFREY GEORGE
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GEORGE
Last Name:ATKINSON
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 1:8880 DUNE LAKE RD SE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-8253
Mailing Address - Country:US
Mailing Address - Phone:509-707-5333
Mailing Address - Fax:
Practice Address - Street 1:1006 W IVY AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2049
Practice Address - Country:US
Practice Address - Phone:509-707-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2015-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health