Provider Demographics
NPI:1083198907
Name:GROVES, JACQUELINE RENE (LMHCA)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:RENE
Last Name:GROVES
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8317 160TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3854
Mailing Address - Country:US
Mailing Address - Phone:425-230-7973
Mailing Address - Fax:
Practice Address - Street 1:8317 160TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3854
Practice Address - Country:US
Practice Address - Phone:425-230-7973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61007684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty