Healthcare Provider Details

I. General information

NPI: 1386112209
Provider Name (Legal Business Name): JONATHAN RYAN MARSH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 11/10/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

IV. Provider business mailing address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-8224
  • Fax:
Mailing address:
  • Phone: 509-747-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60897117
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60897117
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60875274
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: