Healthcare Provider Details

I. General information

NPI: 1174898027
Provider Name (Legal Business Name): JENNIFER ANNE WHITE LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2012
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6926 NE FOURTH PLAIN BLVD
VANCOUVER WA
98661-7254
US

IV. Provider business mailing address

13204 NE 57TH AVE
VANCOUVER WA
98686-4927
US

V. Phone/Fax

Practice location:
  • Phone: 360-993-3000
  • Fax:
Mailing address:
  • Phone: 719-291-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60354447
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLH60354447
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: