Healthcare Provider Details

I. General information

NPI: 1003690280
Provider Name (Legal Business Name): JENNA EADY LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 11TH AVE W APT A
SEATTLE WA
98119-2856
US

IV. Provider business mailing address

2112 11TH AVE W APT A
SEATTLE WA
98119-2856
US

V. Phone/Fax

Practice location:
  • Phone: 206-351-5709
  • Fax:
Mailing address:
  • Phone: 206-351-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61461416
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: