Healthcare Provider Details

I. General information

NPI: 1174055123
Provider Name (Legal Business Name): JAMIE FREDEEN LMFTA, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 06/16/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 NE MAPLE LEAF PL APT A
SEATTLE WA
98115-5378
US

IV. Provider business mailing address

1037 NE 65TH ST # 122
SEATTLE WA
98115-6655
US

V. Phone/Fax

Practice location:
  • Phone: 206-659-7731
  • Fax:
Mailing address:
  • Phone: 206-659-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60905331
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: