Provider Demographics
NPI:1841700333
Name:JERAISEH, DAVID (LMFTA, CMHS, EMMHS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JERAISEH
Suffix:
Gender:M
Credentials:LMFTA, CMHS, EMMHS
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:JERAISEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFTA, CMHS, EMMHS
Mailing Address - Street 1:2600 SW HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3505
Mailing Address - Country:US
Mailing Address - Phone:206-972-9339
Mailing Address - Fax:206-933-7297
Practice Address - Street 1:515 W HARRISON ST STE 109
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4403
Practice Address - Country:US
Practice Address - Phone:253-856-9000
Practice Address - Fax:253-520-6647
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60811385106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist