Provider Demographics
NPI:1285981266
Name:FROST, JESSICA ELENA (LH60856501)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ELENA
Last Name:FROST
Suffix:
Gender:F
Credentials:LH60856501
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-4033
Mailing Address - Country:US
Mailing Address - Phone:253-523-0063
Mailing Address - Fax:253-357-0722
Practice Address - Street 1:902 S WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-4033
Practice Address - Country:US
Practice Address - Phone:253-523-0063
Practice Address - Fax:253-357-0722
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60856501101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health