Healthcare Provider Details

I. General information

NPI: 1295074193
Provider Name (Legal Business Name): DR. JENNIFER LEIGH BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21907 64TH AVE W STE 200
MOUNTLAKE TERRACE WA
98043-6200
US

IV. Provider business mailing address

7090 N ORACLE RD STE 178 PMB 1137
TUCSON AZ
85704-4383
US

V. Phone/Fax

Practice location:
  • Phone: 425-640-7009
  • Fax:
Mailing address:
  • Phone: 480-608-5471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5738
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21339
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60623881
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: