Healthcare Provider Details

I. General information

NPI: 1366067803
Provider Name (Legal Business Name): DARCY JACQUET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL
VANCOUVER WA
98683-9591
US

IV. Provider business mailing address

5807 NE 51ST AVE
VANCOUVER WA
98661-2192
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax:
Mailing address:
  • Phone: 360-798-2795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH61031030
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61031030
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: