Healthcare Provider Details

I. General information

NPI: 1699931477
Provider Name (Legal Business Name): MARY JANE APPLE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 OSPREY GLEN RD
SEQUIM WA
98382-9799
US

IV. Provider business mailing address

PO BOX 963
SEQUIM WA
98382-0963
US

V. Phone/Fax

Practice location:
  • Phone: 360-460-5297
  • Fax:
Mailing address:
  • Phone: 360-460-5297
  • Fax: 360-683-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00010177
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: