Provider Demographics
NPI:1508260746
Name:JENNIFER CROKE PSYCHOTHERAPY
Entity Type:Organization
Organization Name:JENNIFER CROKE PSYCHOTHERAPY
Other - Org Name:SOUTH SOUND COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROKE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:917-975-7712
Mailing Address - Street 1:31919 1ST AVE S
Mailing Address - Street 2:203
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5236
Mailing Address - Country:US
Mailing Address - Phone:253-839-4172
Mailing Address - Fax:
Practice Address - Street 1:31919 1ST AVE S
Practice Address - Street 2:203
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5236
Practice Address - Country:US
Practice Address - Phone:253-839-4172
Practice Address - Fax:206-429-2738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 00009685261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health