Provider Demographics
NPI:1194085761
Name:AGUIRRE, JACK STEPHEN (LMFT)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:STEPHEN
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28781
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-0781
Mailing Address - Country:US
Mailing Address - Phone:360-318-6375
Mailing Address - Fax:
Practice Address - Street 1:1000 MCKENZIE AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7003
Practice Address - Country:US
Practice Address - Phone:360-318-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist