Healthcare Provider Details

I. General information

NPI: 1215424593
Provider Name (Legal Business Name): JENNIFER E HIGGS-COULTHARD MA, MHP, LMHC,CHAFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 KENYON ST. NW #102
OLYMPIA WA
98502
US

IV. Provider business mailing address

221 KENYON ST. NW #102
OLYMPIA WA
98502
US

V. Phone/Fax

Practice location:
  • Phone: 253-720-1613
  • Fax:
Mailing address:
  • Phone: 253-720-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61185418
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO608224345
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMG60953859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: