Provider Demographics
NPI:1205954864
Name:JUDITH JANIS, M.A.
Entity type:Organization
Organization Name:JUDITH JANIS, M.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JANIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-221-8101
Mailing Address - Street 1:5275 DOE RUN LN
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-8504
Mailing Address - Country:US
Mailing Address - Phone:360-221-8101
Mailing Address - Fax:
Practice Address - Street 1:919 3RD ST STE 101
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9229
Practice Address - Country:US
Practice Address - Phone:360-221-8101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020703LH00003880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty