MEDICARE: JACOB LUKE COLLING LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770139065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB LUKE COLLING LCSW

Provider Business Mailing Address
First Line	:	108 S JACKSON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-3802
Country	:	US
Telephone Number	:	971-238-9722
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 S JACKSON ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-3802
Country	:	US
Telephone Number	:	971-238-9722
Fax Number	:

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

Provider Enumeration Date	:	08/13/2019
Last Update Date	:	04/13/2026

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