Provider Demographics
NPI:1982912374
Name:FUENTES, JENNIFER D (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 RAINIER AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-1912
Mailing Address - Country:US
Mailing Address - Phone:206-678-7060
Mailing Address - Fax:
Practice Address - Street 1:502 RAINIER AVE S STE 204
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-1912
Practice Address - Country:US
Practice Address - Phone:206-678-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61478744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101Y00000XMedicaid