MEDICARE: JAYME KOERSELMAN M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH00010905	WA

General Provider Information

NPI Number	:	1154538668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYME KOERSELMAN M.A.

Provider Business Mailing Address
First Line	:	11612 N ASHLEY LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2728
Country	:	US
Telephone Number	:	509-842-6757
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W HASTINGS RD STE 4
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-2877
Country	:	US
Telephone Number	:	509-842-6757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	02/27/2019

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