Healthcare Provider Details

I. General information

NPI: 1093175879
Provider Name (Legal Business Name): JENNIFER SOUSA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 191
LANGLEY WA
98260-0191
US

IV. Provider business mailing address

PO BOX 191
LANGLEY WA
98260-0191
US

V. Phone/Fax

Practice location:
  • Phone: 508-971-0147
  • Fax:
Mailing address:
  • Phone: 508-971-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number729
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number83546
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61123618
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: