Provider Demographics
NPI:1568058576
Name:PAHL, JAHNA (LMHC-A, LMFT)
Entity Type:Individual
Prefix:
First Name:JAHNA
Middle Name:
Last Name:PAHL
Suffix:
Gender:F
Credentials:LMHC-A, LMFT
Other - Prefix:
Other - First Name:VIKKI
Other - Middle Name:
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9311 SE 36TH ST STE 118
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3700
Mailing Address - Country:US
Mailing Address - Phone:415-824-2248
Mailing Address - Fax:
Practice Address - Street 1:9311 SE 36TH ST STE 118
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3700
Practice Address - Country:US
Practice Address - Phone:415-824-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79311106H00000X
WAMC61072651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist