Provider Demographics
NPI:1043642978
Name:TIBBETTS, JENNIFER M (MED, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:TIBBETTS
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18209 SR 410 E
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-5146
Mailing Address - Country:US
Mailing Address - Phone:253-229-0322
Mailing Address - Fax:
Practice Address - Street 1:18209 SR 410 E
Practice Address - Street 2:SUITE 304
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-5146
Practice Address - Country:US
Practice Address - Phone:253-229-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health