Provider Demographics
NPI:1194114710
Name:OPEDAL, JAN (MS CLINICAL PSYCH)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:OPEDAL
Suffix:
Gender:M
Credentials:MS CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5262 OLYMPIC DR NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1795
Mailing Address - Country:US
Mailing Address - Phone:425-577-8990
Mailing Address - Fax:
Practice Address - Street 1:5262 OLYMPIC DR NW
Practice Address - Street 2:SUITE C
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1795
Practice Address - Country:US
Practice Address - Phone:425-577-8990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA 60520453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health