Provider Demographics
NPI:1811139389
Name:KIMURA, JESALYN NOEL (LMHC)
Entity type:Individual
Prefix:MS
First Name:JESALYN
Middle Name:NOEL
Last Name:KIMURA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:JESALYN
Other - Middle Name:NOEL
Other - Last Name:GREENLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2119 N OAKES ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7615
Mailing Address - Country:US
Mailing Address - Phone:253-691-4233
Mailing Address - Fax:
Practice Address - Street 1:2119 N OAKES ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7615
Practice Address - Country:US
Practice Address - Phone:253-691-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00010976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health