Healthcare Provider Details

I. General information

NPI: 1326333535
Provider Name (Legal Business Name): JACQUELINE MARIE CONQUEST MA., LMHC., CCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 351
CARNATION WA
98014-0351
US

IV. Provider business mailing address

PO BOX 351
CARNATION WA
98014-0351
US

V. Phone/Fax

Practice location:
  • Phone: 206-303-9482
  • Fax:
Mailing address:
  • Phone: 206-303-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 00006954
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: