Provider Demographics
NPI:1275966293
Name:SHERIDAN, JENNY (CSOTP, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:CSOTP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:WILKESON
Mailing Address - State:WA
Mailing Address - Zip Code:98396-0403
Mailing Address - Country:US
Mailing Address - Phone:206-755-8661
Mailing Address - Fax:888-220-6946
Practice Address - Street 1:34617 11TH PLACE SOUTH
Practice Address - Street 2:SUITE 107
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8706
Practice Address - Country:US
Practice Address - Phone:206-755-8661
Practice Address - Fax:888-220-6946
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60249739101YM0800X
WAAF60251611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health