MEDICARE: JAMIE KOSTEK LMHC

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	101YM0800X	Mental Health Counselor	LH61262345	WA

General Provider Information

NPI Number	:	1932740636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE KOSTEK LMHC

Provider Business Mailing Address
First Line	:	2342 NW 96TH ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-2548
Country	:	US
Telephone Number	:	206-581-0449
Fax Number	:

Provider Business Practice Location Address
First Line	:	5306 BALLARD AVE NW STE 309
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98107-4366
Country	:	US
Telephone Number	:	206-581-0449
Fax Number	:

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

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	10/17/2022

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