Healthcare Provider Details

I. General information

NPI: 1982865572
Provider Name (Legal Business Name): JAZELLE LYNETTE WASHINGTON LPCC #8715
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

IV. Provider business mailing address

755 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4504
  • Fax:
Mailing address:
  • Phone: 415-642-4504
  • Fax: 415-695-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8715
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: