Provider Demographics
NPI:1679093991
Name:WASHINGTON, JEFFERY
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 S DAHLIA ST APT E32
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2824
Mailing Address - Country:US
Mailing Address - Phone:720-569-6241
Mailing Address - Fax:
Practice Address - Street 1:1066 S. DAHLIA ST. E32
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:720-569-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health