Provider Demographics
NPI:1679966592
Name:WADE, JENNIFER BEHRENS (LMHC, MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BEHRENS
Last Name:WADE
Suffix:
Gender:F
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KATHLEEN
Other - Last Name:BEHRENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1100 NE 45TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4683
Mailing Address - Country:US
Mailing Address - Phone:206-926-9087
Mailing Address - Fax:206-632-7685
Practice Address - Street 1:1100 NE 45TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4683
Practice Address - Country:US
Practice Address - Phone:206-926-9087
Practice Address - Fax:206-632-7685
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60528121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health