Provider Demographics
NPI:1588116024
Name:ST JACQUES CONSULTING GROUP LLC
Entity type:Organization
Organization Name:ST JACQUES CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:425-780-4499
Mailing Address - Street 1:22722 29TH DR SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-4401
Mailing Address - Country:US
Mailing Address - Phone:425-780-4499
Mailing Address - Fax:949-266-5784
Practice Address - Street 1:22722 29TH DR SE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-4401
Practice Address - Country:US
Practice Address - Phone:425-780-4499
Practice Address - Fax:949-266-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-01
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60116269101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty