Provider Demographics
NPI:1811216195
Name:BROWN, JESSI EDEN (MS, LMHC, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:JESSI
Middle Name:EDEN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, LMHC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 NE 178TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4533
Mailing Address - Country:US
Mailing Address - Phone:253-886-6153
Mailing Address - Fax:
Practice Address - Street 1:4714 NE 178TH ST
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-4533
Practice Address - Country:US
Practice Address - Phone:253-886-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009028101YM0800X
COLPC-4029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional