MEDICARE: JENNIFER L FARNHAM LMFTA

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	106H00000X	Marriage & Family Therapist	MG61424222	WA

General Provider Information

NPI Number	:	1154064293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER L FARNHAM LMFTA

Provider Business Mailing Address
First Line	:	320 W GALER ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-3065
Country	:	US
Telephone Number	:	619-384-7087
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W GALER ST STE 101
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98119-3065
Country	:	US
Telephone Number	:	619-384-7087
Fax Number	:

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

Provider Enumeration Date	:	04/17/2022
Last Update Date	:	12/11/2024

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