Provider Demographics
NPI:1720498181
Name:ANTHONY, JESSICA (MA, LMHCA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5624 7TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2729
Mailing Address - Country:US
Mailing Address - Phone:206-384-4142
Mailing Address - Fax:
Practice Address - Street 1:24 ROY ST # 434
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4018
Practice Address - Country:US
Practice Address - Phone:206-384-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC60461664OtherMENTAL HEALTH COUNSELOR ASSOCIATE LICENSE
WACG60436179OtherAGENCY AFFILIATED COUNSELOR REGISTRATION