Provider Demographics
NPI:1982794426
Name:JANIS, JUDITH E (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:E
Last Name:JANIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:360-321-8258
Mailing Address - Fax:360-221-2515
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:360-221-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA020703LH00003880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health