Healthcare Provider Details

I. General information

NPI: 1538981394
Provider Name (Legal Business Name): JESSICA RENEE HOVLAND LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 BRIDGEPORT WAY W STE 2C
UNIVERSITY PLACE WA
98466-4446
US

IV. Provider business mailing address

3560 BRIDGEPORT WAY W STE 2C
UNIVERSITY PLACE WA
98466-4446
US

V. Phone/Fax

Practice location:
  • Phone: 253-460-7248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG61610997
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: