Healthcare Provider Details

I. General information

NPI: 1215859194
Provider Name (Legal Business Name): JESSICA GOMES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 WILLOWS RD NE
REDMOND WA
98052-2531
US

IV. Provider business mailing address

PO BOX 171
CARNATION WA
98014-0171
US

V. Phone/Fax

Practice location:
  • Phone: 425-394-6125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70158572
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: