Active NPI
Jaceya Prophet
- Counselor
- Spokane, WA
National Provider Identifier
1477201390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG61151835
- Practice address
- 124 E Pacific Ave
Spokane, WA 99202-1518 - Phone
- (509) 838-4651
- NPI assigned
- Mar 10, 2022
- Last updated
- Mar 10, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG61151835 | WA | Primary |
Addresses
Primary practice location
124 E Pacific Ave
Spokane, WA 99202-1518
Mailing address
107 S Division St
Spokane, WA 99202-1510
Phone (509) 838-4651
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG61151835 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646870400000",
"number": "1477201390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 S DIVISION ST",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992021510",
"telephone_number": "509-838-4651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 E PACIFIC AVE",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992021518",
"telephone_number": "509-838-4651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROPHET",
"first_name": "JACEYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-03-10",
"last_updated": "2022-03-10",
"certification_date": "2022-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG61151835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.