Basic Information
| Provider Information | |||||||||
| NPI: | 1588006340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEOT | ||||||||
| FirstName: | JEWEL | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PHD, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13110 NE 177TH PL # 154 | ||||||||
| Address2: | |||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980725740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089376134 | ||||||||
| FaxNumber: | 5414476694 | ||||||||
| Practice Location | |||||||||
| Address1: | 19900 174TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | WOODINVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980727012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252987501 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.