1790278711 NPI number — JACLIN LEE BELABRI LMHC

Table of content: JACLIN LEE BELABRI LMHC (NPI 1790278711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790278711 NPI number — JACLIN LEE BELABRI LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELABRI
Provider First Name:
JACLIN
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790278711
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 SE 160TH AVE, STE 103
Provider Second Line Business Mailing Address:
#255
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-818-1422
Provider Business Mailing Address Fax Number:
360-258-1895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15907 NE 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-818-1422
Provider Business Practice Location Address Fax Number:
360-397-0371
Provider Enumeration Date:
06/13/2018

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: 101Y00000X , with the licence number:  MC60859158 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH61127516 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: LH61127516 , 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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