1396022471 NPI number — MS. JENNIFER LOUISE EASLEY LMHC; NCC

Table of content: MS. JENNIFER LOUISE EASLEY LMHC; NCC (NPI 1396022471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396022471 NPI number — MS. JENNIFER LOUISE EASLEY LMHC; NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASLEY
Provider First Name:
JENNIFER
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC; NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOTTS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396022471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20407 87TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VASHON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98070-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-300-3142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20407 87TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VASHON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98070-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-300-3142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH00006074 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)