MEDICARE: MR. JASON MATTHEW CAIN

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	101Y00000X	Counselor	CG60768765	WA

General Provider Information

NPI Number	:	1649788811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON MATTHEW CAIN

Provider Business Mailing Address
First Line	:	4405 7TH AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1062
Country	:	US
Telephone Number	:	360-413-0046
Fax Number	:	360-413-0586

Provider Business Practice Location Address
First Line	:	4405 7TH AVE SE
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1062
Country	:	US
Telephone Number	:	360-413-0046
Fax Number	:	360-413-0586

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

Provider Enumeration Date	:	01/22/2018
Last Update Date	:	01/22/2018

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