=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962593293
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER SUE WAREHAM LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 DEER HARBOR RD
-----------------------------------------------------
City | EASTSOUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98245-9201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-626-7293
-----------------------------------------------------
Fax | 360-850-2037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 DEER HARBOR RD
-----------------------------------------------------
City | EASTSOUND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98245-9201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-626-7293
-----------------------------------------------------
Fax | 360-850-0237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 770
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 51363653902
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 6229
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 60642442
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------