MEDICARE: JESSICA KOLLE 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	LH60563538	WA

General Provider Information

NPI Number	:	1831631944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KOLLE LMHC

Provider Business Mailing Address
First Line	:	7304 10TH ST SE
Second Line	:	#B201
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3684
Country	:	US
Telephone Number	:	425-954-3450
Fax Number	:

Provider Business Practice Location Address
First Line	:	7304 10TH ST SE
Second Line	:	#B201
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-3684
Country	:	US
Telephone Number	:	425-954-3450
Fax Number	:

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

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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