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General NPI Number Information
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NPI Number | 1932742392
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Entity Type | Individual
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Provider Name | JEREMY MOOT LMHCA
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Gender | Male
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 819 N 49TH ST STE 417
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City | SEATTLE
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State | WA
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Zip | 98103-6577
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Country | US
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Telephone | 240-366-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 N 79TH ST APT 101
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City | SEATTLE
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State | WA
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Zip | 98103-4851
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Country | US
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Telephone |
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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 | MC60966769
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License Number State | WA
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