Healthcare Provider Details

I. General information

NPI: 1215369871
Provider Name (Legal Business Name): JOLENE JANEL WUEST M.S. LMHC, CMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8312 CUSTER RD SW
LAKEWOOD WA
98499-2526
US

IV. Provider business mailing address

1797 CADBOROUGH LN
DUPONT WA
98327-8796
US

V. Phone/Fax

Practice location:
  • Phone: 253-306-5103
  • Fax: 253-306-5103
Mailing address:
  • Phone: 253-306-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60558824
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: