1730487539 NPI number — L. JENAE MACNAUGHTON LMHC, LPC, LPC-S

Table of content: L. JENAE MACNAUGHTON LMHC, LPC, LPC-S (NPI 1730487539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730487539 NPI number — L. JENAE MACNAUGHTON LMHC, LPC, LPC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACNAUGHTON
Provider First Name:
L. JENAE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LPC, LPC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
L. JENAE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730487539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1644 PLAZA WAY
Provider Second Line Business Mailing Address:
302
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-876-8065
Provider Business Mailing Address Fax Number:
509-524-2993

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1644 PLAZA WAY
Provider Second Line Business Practice Location Address:
302
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-876-8065
Provider Business Practice Location Address Fax Number:
509-524-2993
Provider Enumeration Date:
03/03/2011

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:  LH00011334 , 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)





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