Provider Demographics
NPI:1790971901
Name:SANDOVAL, JENNIFER EIRE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EIRE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:DEVOID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:16300 CHRISTENSEN RD STE 108
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3418
Mailing Address - Country:US
Mailing Address - Phone:206-851-4881
Mailing Address - Fax:
Practice Address - Street 1:16300 CHRISTENSEN RD STE 108
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3418
Practice Address - Country:US
Practice Address - Phone:206-851-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60097173101YM0800X
WA601800019101YM0800X
101YM0800X
WALH601800019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health