Healthcare Provider Details

I. General information

NPI: 1437989829
Provider Name (Legal Business Name): JARED YSLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 N HIGHLAND ST
TACOMA WA
98406-2839
US

IV. Provider business mailing address

1807 N HIGHLAND ST
TACOMA WA
98406-2839
US

V. Phone/Fax

Practice location:
  • Phone: 253-306-1929
  • Fax:
Mailing address:
  • Phone: 253-306-1929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61516406
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61642358
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: