Provider Demographics
NPI:1053711952
Name:DEMICK, JESSICA RUTH (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUTH
Last Name:DEMICK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RUTH
Other - Last Name:AMBURGEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6424 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2091
Mailing Address - Country:US
Mailing Address - Phone:253-565-4484
Mailing Address - Fax:253-565-5823
Practice Address - Street 1:6316 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-1900
Practice Address - Country:US
Practice Address - Phone:253-565-4484
Practice Address - Fax:253-565-5823
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60474062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health