Provider Demographics
NPI:1104323443
Name:MAY, JACQUELINE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MASTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:PMB 8550
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507
Mailing Address - Country:US
Mailing Address - Phone:206-548-4020
Mailing Address - Fax:
Practice Address - Street 1:587 6TH AVE # 6
Practice Address - Street 2:
Practice Address - City:FOX ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98333-9740
Practice Address - Country:US
Practice Address - Phone:206-548-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
WALH61006357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health