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General NPI Number Information
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NPI Number | 1134734106
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Entity Type | Individual
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Provider Name | JANATHAN GRACE LMHC
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Gender | Male
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 9119 RIDGETOP BLVD NW STE 220
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City | SILVERDALE
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State | WA
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Zip | 98383-8549
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Country | US
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Telephone | 360-516-0728
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Fax |
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Provider Business Mailing Address
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Address Line | 40 NE SKIPPER CT
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City | BELFAIR
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State | WA
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Zip | 98528-9258
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Country | US
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Telephone | 434-609-2004
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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 | LH61258275
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License Number State | WA
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