1215132303 NPI number — MR. KENNETH JAY SEATON SR. M.S., LMHC, CSAT

Table of content: MR. KENNETH JAY SEATON SR. M.S., LMHC, CSAT (NPI 1215132303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215132303 NPI number — MR. KENNETH JAY SEATON SR. M.S., LMHC, CSAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEATON
Provider First Name:
KENNETH
Provider Middle Name:
JAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
M.S., LMHC, CSAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215132303
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14155 GLENWOOD RD SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98367-7769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-876-2765
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3208 50TH STREET CT NW
Provider Second Line Business Practice Location Address:
BLDG C, SUITE 100
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-8590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-621-9286
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00004211 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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