Healthcare Provider Details

I. General information

NPI: 1043933260
Provider Name (Legal Business Name): MR. JOHN WAYNE HIGSON III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 VIRGINIA ST UNIT 1703
SEATTLE WA
98101-4425
US

IV. Provider business mailing address

819 VIRGINIA ST UNIT 1703
SEATTLE WA
98101-4425
US

V. Phone/Fax

Practice location:
  • Phone: 925-878-1532
  • Fax:
Mailing address:
  • Phone: 925-878-1532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMG61269730
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF61597963
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: