Provider Demographics
NPI:1124172846
Name:BAXTER, JEFFREY W (MA LMFT LMHC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:W
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MA LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 SE 240TH
Mailing Address - Street 2:SUITE 116 JAMES STREET BUILDING
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031
Mailing Address - Country:US
Mailing Address - Phone:253-852-2250
Mailing Address - Fax:253-850-2856
Practice Address - Street 1:10024 SE 240TH
Practice Address - Street 2:SUITE 116 JAMES STREET BUILDING
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031
Practice Address - Country:US
Practice Address - Phone:253-852-2250
Practice Address - Fax:253-850-2856
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3480101YM0800X
WA1035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist