MEDICARE: JONATHAN DAVIS

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	LF61078528	WA
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1972074342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN DAVIS

Provider Business Mailing Address
First Line	:	711 N 35TH ST APT 206
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-3420
Country	:	US
Telephone Number	:	503-395-8337
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 N 35TH ST APT 206
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-3420
Country	:	US
Telephone Number	:	425-367-1089
Fax Number	:

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

Provider Enumeration Date	:	12/11/2018
Last Update Date	:	12/13/2022

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Directions to “ JONATHAN DAVIS ” Practice Location

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