Individual
JASON R ELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSWA, MSW
Contact information
Practice address
4200 6TH AVE SE STE 201, LACEY, WA 98503-1042
(564) 669-0130
Mailing address
3608 ANDRESS ST NE, LACEY, WA 98516-3404
(719) 287-5545
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
SC61356908
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC61356908
WASHINGTON STATE DEPARTMENT OF HEALTH
WA
Enumeration date
09/25/2023
Last updated
09/25/2023
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