MEDICARE: MS. TRUUS HELENA JANSEN MA LMFT

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	101YP2500X	Professional Counselor	C1369	OR
2	106H00000X	Marriage & Family Therapist	LF00002609	WA

General Provider Information

NPI Number	:	1649568163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRUUS HELENA JANSEN MA LMFT

Provider Business Mailing Address
First Line	:	7001 HOLLY PARK DR S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3525
Country	:	US
Telephone Number	:	206-818-7188
Fax Number	:	206-402-5441

Provider Business Practice Location Address
First Line	:	7001 HOLLY PARK DR S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-3525
Country	:	US
Telephone Number	:	206-818-7188
Fax Number	:	206-402-5441

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	07/18/2011

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