Healthcare Provider Details

I. General information

NPI: 1205954864
Provider Name (Legal Business Name): JUDITH JANIS, M.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 3RD ST STE 101
LANGLEY WA
98260-9229
US

IV. Provider business mailing address

5275 DOE RUN LN
LANGLEY WA
98260-8504
US

V. Phone/Fax

Practice location:
  • Phone: 360-221-8101
  • Fax:
Mailing address:
  • Phone: 360-221-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number020703LH00003880
License Number StateWA

VIII. Authorized Official

Name: JUDITH JANIS
Title or Position: MENTAL HEALTH COUNSELOR
Credential: L.M.H.C.
Phone: 360-221-8101