MEDICARE: JEAN W EAKINS LMFT

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	106H00000X	Marriage & Family Therapist	LF918	WA

General Provider Information

NPI Number	:	1578522629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN W EAKINS LMFT

Provider Business Mailing Address
First Line	:	5009 TALBOT PL S
Second Line	:	UNIT D
City	:	RENTON
State	:	WA
Zip	:	98055-7931
Country	:	US
Telephone Number	:	425-226-6438
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 EDMONDS AVE NE
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-2713
Country	:	US
Telephone Number	:	425-271-9711
Fax Number	:

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	07/08/2007

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