Provider Demographics
NPI:1649661299
Name:FELICITAS, JENNIFER (LMHCA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FELICITAS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4196
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99302-4196
Mailing Address - Country:US
Mailing Address - Phone:509-438-5126
Mailing Address - Fax:866-366-5004
Practice Address - Street 1:3801 S ZINTEL WAY STE 120
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5097
Practice Address - Country:US
Practice Address - Phone:509-438-5126
Practice Address - Fax:866-366-5004
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60480925101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health