Provider Demographics
NPI:1215424593
Name:HIGGS-COULTHARD, JENNIFER E (MA, MHP, LMHC, SUDP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:HIGGS-COULTHARD
Suffix:
Gender:F
Credentials:MA, MHP, LMHC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 PACIFIC AVE SE # 6
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2085
Mailing Address - Country:US
Mailing Address - Phone:253-720-1613
Mailing Address - Fax:
Practice Address - Street 1:2608 PACIFIC AVE SE # 6
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2085
Practice Address - Country:US
Practice Address - Phone:253-720-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-22
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO608224345101YA0400X
WALH61185418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA92-0963115Medicaid