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General NPI Number Information
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NPI Number | 1255043394
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Entity Type | Individual
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Provider Name | JILLIAN LAINE VISSCHER LMHC
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Gender | Female
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Dates
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Enumeration Date | 12/20/2022
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 1498 SE TECH CENTER PL STE 300
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City | VANCOUVER
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State | WA
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Zip | 98683-5509
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Country | US
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Telephone | 360-619-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 18861 ALLEGHENY DR
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City | OREGON CITY
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State | OR
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Zip | 97045-3905
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Country | US
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Telephone | 503-887-9210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61582831
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License Number State | WA
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