Individual
JACK WYATT BEAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
17018 15TH AVE NE, SHORELINE, WA 98155-5137
(206) 362-7282
Mailing address
17018 15TH AVE NE, SHORELINE, WA 98155-5137
(206) 362-7282
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
CG61247132
WA
104100000X
Social Worker
Primary
LW70069003
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/03/2022
Last updated
08/06/2026
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