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NPI Code Detail

MEDICARE: JESSICA L MINCKLEY LMHC, ATR-P

MEDICARE:   JESSICA L MINCKLEY  LMHC, ATR-P
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMC61327714WA
2221700000XArt TherapistATRP22455

General Provider Information

NPI Number : 1790401339
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L MINCKLEY LMHC, ATR-P
Provider Business Mailing Address
First Line : 536 NE 97TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2126
Country : US
Telephone Number : 503-926-0081
Fax Number :
Provider Business Practice Location Address
First Line : 536 NE 97TH ST
Second Line :
City : SEATTLE
State : WA
Zip : 98115-2126
Country : US
Telephone Number : 503-926-0081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2022
Last Update Date : 12/08/2023

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