Active NPI
Jettson Davis
- Mental Health Counselor
- Silverdale, WA
National Provider Identifier
1609540350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 9307 Bay Shore Dr NW Ste 306
Silverdale, WA 98383-8219 - Phone
- (360) 230-8071
- NPI assigned
- Aug 5, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
9307 Bay Shore Dr NW Ste 306
Silverdale, WA 98383-8219
Mailing address
PO Box 318
Poulsbo, WA 98370-0318
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Sep 10, 2024 through Sep 10, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713312000000",
"number": "1609540350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 318",
"city": "POULSBO",
"state": "WA",
"postal_code": "983700318"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9307 BAY SHORE DR NW STE 306",
"city": "SILVERDALE",
"state": "WA",
"postal_code": "983838219",
"telephone_number": "360-230-8071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "JETTSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-08-05",
"last_updated": "2024-04-17",
"certification_date": "2024-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Silverdale, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.