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NPI Code Detail

MEDICARE: JET CITY PSYCHOLOGICAL SERVICES, PLLC

MEDICARE: JET CITY PSYCHOLOGICAL SERVICES, PLLC
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11285861377OTHERWANPI

General Provider Information

NPI Number : 1639876329
Entity Type Code : Organization
Provider Name (Legal Business Name) : JET CITY PSYCHOLOGICAL SERVICES, PLLC
Provider Business Mailing Address
First Line : 3500 SW ALASKA ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-2731
Country : US
Telephone Number : 206-414-9498
Fax Number :
Provider Business Practice Location Address
First Line : 3500 SW ALASKA ST
Second Line :
City : SEATTLE
State : WA
Zip : 98126-2731
Country : US
Telephone Number : 206-414-9498
Fax Number :
Authorized Official
Title or Position : PSYCHOLOGIST
Name : DR. JANELLE PAINTER
Credential : PHD
Telephone Number : 206-414-9498
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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