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General NPI Number Information
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NPI Number | 1497028823
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Entity Type | Individual
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Provider Name | JC EPHRAIM JR. CCC, SUDP, MHP, CAAL
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Gender | Male
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 07/12/2025
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Provider Practice Location Address
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Address Line | 15 S GRADY WAY STE 310
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City | RENTON
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State | WA
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Zip | 98057-3215
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Country | US
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Telephone | 206-726-0430
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6385
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City | KENT
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State | WA
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Zip | 98064-6385
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Country | US
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Telephone | 206-650-4024
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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 | CL60461451
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CU61584983
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CP00001663
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License Number State | WA
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