Healthcare Provider Details

I. General information

NPI: 1336487990
Provider Name (Legal Business Name): RENEE JONES LMHCA, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 FRONT ST N
ISSAQUAH WA
98027-2914
US

IV. Provider business mailing address

414 FRONT ST N
ISSAQUAH WA
98027-2914
US

V. Phone/Fax

Practice location:
  • Phone: 425-392-6367
  • Fax:
Mailing address:
  • Phone: 254-392-6367
  • Fax: 425-391-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60068231
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60829353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: