Healthcare Provider Details

I. General information

NPI: 1255043394
Provider Name (Legal Business Name): JILLIAN LAINE VISSCHER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN VISSCHER AULBACH

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

18861 ALLEGHENY DR
OREGON CITY OR
97045-3905
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax:
Mailing address:
  • Phone: 503-887-9210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61582831
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: