Provider Demographics
NPI:1316181738
Name:RICHARDSON, JASON LAVAR (MSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LAVAR
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11707 E SPRAGUE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6110
Mailing Address - Country:US
Mailing Address - Phone:509-926-6581
Mailing Address - Fax:509-921-1375
Practice Address - Street 1:11707 E SPRAGUE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6110
Practice Address - Country:US
Practice Address - Phone:509-926-6581
Practice Address - Fax:509-921-1375
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057314101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor