MEDICARE: JENNIFER JOHN 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

General Provider Information

NPI Number	:	1922701820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER JOHN LMHCA

Provider Business Mailing Address
First Line	:	1405 NW 85TH ST # 4
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-4237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 NE 67TH ST APT 306
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-5761
Country	:	US
Telephone Number	:	925-451-9188
Fax Number	:

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

Provider Enumeration Date	:	03/22/2023
Last Update Date	:	03/22/2023

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