MEDICARE: JARRED LATHROP-WEBER LMHCA, MHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	MC60166564	WA

General Provider Information

NPI Number	:	1275804783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARRED LATHROP-WEBER LMHCA, MHP

Provider Business Mailing Address
First Line	:	1812 E MADISON ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-2876
Country	:	US
Telephone Number	:	253-906-8738
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 46TH AVE S UNIT B
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-5001
Country	:	US
Telephone Number	:	253-906-8738
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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