Healthcare Provider Details

I. General information

NPI: 1144689159
Provider Name (Legal Business Name): JENNIFER LANDAVERDE LMHCA, LMFTA, MHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5031 UNIVERSITY WAY NE # 105
SEATTLE WA
98105-4341
US

IV. Provider business mailing address

4554 DELRIDGE WAY SW
SEATTLE WA
98106-1327
US

V. Phone/Fax

Practice location:
  • Phone: 206-427-0115
  • Fax:
Mailing address:
  • Phone: 253-221-7461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60990301
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: