| Doctor Name: | DR. KEVIN WAYNE ST JACQUES |
| NPI Number: | 1538226444 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSY.D., LMHC |
| License Number: | LH60116269 |
| Business Practice Address: | 17508 20th Dr Se Bothell, WA - 980126406 |
| Business Phone Number: | 2064958562 |
| Business Fax Number: | |
| Mailing Address: | 17508 20th Dr Se, BOTHELL |
| State: | WA |
| Postal Code: | 980126406 |
| Phone Number: | 2064958562 |
| Fax Number: | |
| NPI Enumeration Date: | 01/02/2007 |
| NPI Last Update Date: | 03/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LH60116269 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |