Healthcare Provider Details

I. General information

NPI: 1104603042
Provider Name (Legal Business Name): JENNIFER HAYSE MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W RIVERSIDE AVE STE 7306
SPOKANE WA
99201-0580
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE 7306
SPOKANE WA
99201-0580
US

V. Phone/Fax

Practice location:
  • Phone: 425-312-3093
  • Fax:
Mailing address:
  • Phone: 425-312-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.LF.70124563
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: