Healthcare Provider Details

I. General information

NPI: 1922922970
Provider Name (Legal Business Name): NICHOLAS JOHN METZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 BAY ST
PORT ORCHARD WA
98366-5111
US

IV. Provider business mailing address

1811 BAY ST
PORT ORCHARD WA
98366-5111
US

V. Phone/Fax

Practice location:
  • Phone: 206-499-7077
  • Fax:
Mailing address:
  • Phone: 206-499-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0023199
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: