Healthcare Provider Details

I. General information

NPI: 1982794426
Provider Name (Legal Business Name): JUDITH E JANIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
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: 360-221-2515
Mailing address:
  • Phone: 360-321-8258
  • Fax: 360-221-2515

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:
Title or Position:
Credential:
Phone: