Provider Demographics
NPI:1215997556
Name:BENNETT, JAN (LMHC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:375 118TH AVE SE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3575
Mailing Address - Country:US
Mailing Address - Phone:425-444-9480
Mailing Address - Fax:866-275-8689
Practice Address - Street 1:375 118TH AVE SE
Practice Address - Street 2:SUITE 210
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3575
Practice Address - Country:US
Practice Address - Phone:425-444-9480
Practice Address - Fax:866-275-8689
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003762101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health