Provider Demographics
NPI:1689764011
Name:LUSTER PAINTER, JAYNE D (LHMC)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:D
Last Name:LUSTER PAINTER
Suffix:
Gender:F
Credentials:LHMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 S 12TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3109
Mailing Address - Country:US
Mailing Address - Phone:509-576-6220
Mailing Address - Fax:509-225-7372
Practice Address - Street 1:411 S 12TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3109
Practice Address - Country:US
Practice Address - Phone:509-576-6220
Practice Address - Fax:509-225-7372
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health