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General NPI Number Information
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NPI Number | 1033516273
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Entity Type | Individual
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Provider Name | DAVID WILLEM JILLSON MA
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Gender | Male
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 1160 140TH AVE NE STE F
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City | BELLEVUE
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State | WA
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Zip | 98005-2978
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Country | US
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Telephone | 425-637-1289
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Fax |
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Provider Business Mailing Address
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Address Line | 4116 CALIFORNIA AVE SW APT 201
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City | SEATTLE
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State | WA
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Zip | 98116-4170
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Country | US
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Telephone | 206-678-3882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 60494723
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License Number State | WA
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