Provider Demographics
NPI:1467281741
Name:BANKA, JARED (MC61577538)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:BANKA
Suffix:
Gender:M
Credentials:MC61577538
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-4201
Mailing Address - Country:US
Mailing Address - Phone:530-410-5481
Mailing Address - Fax:
Practice Address - Street 1:16150 NE 85TH ST STE 222B
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3546
Practice Address - Country:US
Practice Address - Phone:831-219-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61577538101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health