Healthcare Provider Details

I. General information

NPI: 1134923600
Provider Name (Legal Business Name): JADE BRANCH COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2247 SE KELLY AVE STE 330
GRESHAM OR
97080-5386
US

IV. Provider business mailing address

600 1ST AVE STE 330
SEATTLE WA
98104-2246
US

V. Phone/Fax

Practice location:
  • Phone: 206-710-7351
  • Fax:
Mailing address:
  • Phone: 206-710-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH HANDLEY
Title or Position: OWNER/OPERATOR
Credential: LICSW
Phone: 206-710-7351