Healthcare Provider Details

I. General information

NPI: 1881052280
Provider Name (Legal Business Name): JOLENE EVA JANACEK MA, LMHCA, SUDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 BONNEVILLE AVE STE 203
SNOHOMISH WA
98290-2087
US

IV. Provider business mailing address

1311 BONNEVILLE AVE STE 203
SNOHOMISH WA
98290-2087
US

V. Phone/Fax

Practice location:
  • Phone: 313-462-9642
  • Fax:
Mailing address:
  • Phone: 425-772-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60962626
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70128914
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMHCA.MC.70128914
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: