Healthcare Provider Details

I. General information

NPI: 1629328596
Provider Name (Legal Business Name): JASON CHRISTOPHER BAILEY MA, LMHC, NCC, SOTP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18221 102ND AVE NE STE C
BOTHELL WA
98011-3466
US

IV. Provider business mailing address

18221 102ND AVE NE STE C
BOTHELL WA
98011-3466
US

V. Phone/Fax

Practice location:
  • Phone: 360-961-0388
  • Fax:
Mailing address:
  • Phone: 360-961-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60804736
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: