MEDICARE: MISS ALIX NICOLE JANSMA LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH61380474	WA

General Provider Information

NPI Number	:	1093589400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALIX NICOLE JANSMA LMHC

Provider Business Mailing Address
First Line	:	10008 NE 120TH LN APT C302
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98034-6629
Country	:	US
Telephone Number	:	860-227-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	13206 BOTHELL EVERETT HWY STE 401A
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-3402
Country	:	US
Telephone Number	:	860-227-8526
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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