MEDICARE: JESS DALE 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	LH60384102	WA

General Provider Information

NPI Number	:	1366840274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESS DALE LMHC

Provider Business Mailing Address
First Line	:	PO BOX 257
Second Line	:	PMB 6832
City	:	OLYMPIA
State	:	WA
Zip	:	98507
Country	:	US
Telephone Number	:	425-276-1459
Fax Number	:

Provider Business Practice Location Address
First Line	:	4864 RAINIER AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1742
Country	:	US
Telephone Number	:	206-451-9405
Fax Number	:

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

Provider Enumeration Date	:	12/09/2014
Last Update Date	:	10/04/2023

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