Provider Demographics
NPI:1174863781
Name:TEMPLE, JENNIE (PSYD, MSW, LMHC)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:PSYD, MSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12600 SE 38TH ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-6105
Mailing Address - Country:US
Mailing Address - Phone:206-399-4057
Mailing Address - Fax:425-526-5800
Practice Address - Street 1:12600 SE 38TH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:206-399-4057
Practice Address - Fax:425-526-5800
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60308302101YM0800X
WAPY60365672103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health