Healthcare Provider Details

I. General information

NPI: 1275804783
Provider Name (Legal Business Name): JARRED LATHROP-WEBER LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 42ND AVE SW APT 320
SEATTLE WA
98116-4620
US

IV. Provider business mailing address

209 12TH AVE S UNIT A546
SEATTLE WA
98144-3090
US

V. Phone/Fax

Practice location:
  • Phone: 253-906-8738
  • Fax:
Mailing address:
  • Phone: 253-906-8738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTA.MG.61468320
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: