Provider Demographics
NPI:1215420963
Name:MARKET STREET PSYCHOTHERAPY, P S
Entity type:Organization
Organization Name:MARKET STREET PSYCHOTHERAPY, P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:MARKOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-403-1374
Mailing Address - Street 1:2208 NW MARKET ST STE 513
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4098
Mailing Address - Country:US
Mailing Address - Phone:206-403-1374
Mailing Address - Fax:206-844-2337
Practice Address - Street 1:2208 NW MARKET ST STE 513
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4098
Practice Address - Country:US
Practice Address - Phone:206-403-1374
Practice Address - Fax:206-844-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD604841012084P0800X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty