Provider Demographics
NPI:1073147484
Name:ST. LOUIS, JACKIE KERNS (LMHC)
Entity Type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:KERNS
Last Name:ST. LOUIS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8506 137TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-6415
Mailing Address - Country:US
Mailing Address - Phone:484-620-3762
Mailing Address - Fax:
Practice Address - Street 1:8506 137TH STREET CT E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-6415
Practice Address - Country:US
Practice Address - Phone:484-620-3762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60689655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health