Provider Demographics
NPI:1093589400
Name:JANSMA, ALIX NICOLE (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:ALIX
Middle Name:NICOLE
Last Name:JANSMA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10008 NE 120TH LN APT C302
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6629
Mailing Address - Country:US
Mailing Address - Phone:860-227-8526
Mailing Address - Fax:
Practice Address - Street 1:13206 BOTHELL EVERETT HWY STE 401A
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-3402
Practice Address - Country:US
Practice Address - Phone:860-227-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61380474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health