Provider Demographics
NPI:1982741781
Name:JEFFERIS, JENNIFER TULL (MED, LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TULL
Last Name:JEFFERIS
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:TULL
Other - Last Name:JEFFERIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED,LMHC
Mailing Address - Street 1:8816 NE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-6400
Mailing Address - Country:US
Mailing Address - Phone:360-254-2961
Mailing Address - Fax:360-828-1944
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3331
Practice Address - Country:US
Practice Address - Phone:360-696-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health