Healthcare Provider Details

I. General information

NPI: 1174410831
Provider Name (Legal Business Name): BROOKE JEFFERSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 NE TOHOMISH ST
WHITE SALMON WA
98672-1940
US

IV. Provider business mailing address

PO BOX 1442
WHITE SALMON WA
98672-1442
US

V. Phone/Fax

Practice location:
  • Phone: 509-866-6846
  • Fax:
Mailing address:
  • Phone: 509-866-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70010470
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR11344
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: