| Doctor Name: | MR. JEREMY JAMES RUTHERFORD |
| NPI Number: | 1457647695 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | |
| Business Practice Address: | 105 Nw 1st St. Coupeville, WA - 98239 |
| Business Phone Number: | 3606825555 |
| Business Fax Number: | |
| Mailing Address: | Po Box 3810, EVERETT |
| State: | WA |
| Postal Code: | 982138810 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/27/2011 |
| NPI Last Update Date: | 06/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |