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NPI Code Detail

MEDICARE: WHITNEY GWENDOLYN JACKSON MA, LMHC, DCR

MEDICARE: WHITNEY GWENDOLYN JACKSON MA, LMHC, DCR
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
1101YM0800XMental Health CounselorMHLH61344373WA

General Provider Information

NPI Number : 1245618487
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY GWENDOLYN JACKSON MA, LMHC, DCR
Provider Business Mailing Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number : 425-349-6200
Fax Number :
Provider Business Practice Location Address
First Line : 4526 FEDERAL AVE
Second Line :
City : EVERETT
State : WA
Zip : 98203-2132
Country : US
Telephone Number : 425-349-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2015
Last Update Date : 04/07/2026

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Directions to “ WHITNEY GWENDOLYN JACKSON MA, LMHC, DCR” Practice Location

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