Provider Demographics
NPI:1235661414
Name:DEBACKER, JANINE KAY (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:KAY
Last Name:DEBACKER
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 1:601 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3402
Mailing Address - Country:US
Mailing Address - Phone:971-222-6924
Mailing Address - Fax:360-695-1393
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3402
Practice Address - Country:US
Practice Address - Phone:971-222-6924
Practice Address - Fax:360-695-1393
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60640839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health