Healthcare Provider Details

I. General information

NPI: 1639033830
Provider Name (Legal Business Name): JOHN JASON CARREON MHCA.MC.70016976
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 WA-532
CAMANO ISLAND WA
98282
US

IV. Provider business mailing address

4155 SE CAMANO DR
CAMANO ISLAND WA
98282-7071
US

V. Phone/Fax

Practice location:
  • Phone: 360-227-5236
  • Fax:
Mailing address:
  • Phone: 210-364-2461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70016976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: