Healthcare Provider Details

I. General information

NPI: 1194652578
Provider Name (Legal Business Name): JOHN JAMES CARLETON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8681 NE FOX DEN LN
BAINBRIDGE ISLAND WA
98110-5117
US

IV. Provider business mailing address

8681 NE FOX DEN LN
BAINBRIDGE ISLAND WA
98110-5117
US

V. Phone/Fax

Practice location:
  • Phone: 503-688-0612
  • Fax:
Mailing address:
  • Phone: 503-688-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC.LH.61619958
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: