MEDICARE: JACKLYN HALIBAS TAN LMHCA

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	70060515	WA

General Provider Information

NPI Number	:	1326994682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN HALIBAS TAN LMHCA

Provider Business Mailing Address
First Line	:	3970 96TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3706
Country	:	US
Telephone Number	:	425-628-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3970 96TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3706
Country	:	US
Telephone Number	:	425-628-0111
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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