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General NPI Number Information
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NPI Number | 1467039339
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Entity Type | Individual
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Provider Name | ELIZABETH JEPPESEN LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 437 29TH ST NE
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City | PUYALLUP
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State | WA
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Zip | 98372-6784
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Country | US
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Telephone | 253-330-7204
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Fax | 253-387-8151
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Provider Business Mailing Address
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Address Line | 2607 BRIDGEPORT WAY W
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4700
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Country | US
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Telephone | 253-330-7204
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Fax | 253-387-8151
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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 | LH60722536
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License Number State | WA
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