Provider Demographics
NPI:1962874388
Name:JELENOVA, TEREZA (MA, LMHCA)
Entity type:Individual
Prefix:
First Name:TEREZA
Middle Name:
Last Name:JELENOVA
Suffix:
Gender:F
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W GALER ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3393
Mailing Address - Country:US
Mailing Address - Phone:360-951-6051
Mailing Address - Fax:
Practice Address - Street 1:316 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3197
Practice Address - Country:US
Practice Address - Phone:360-951-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-25
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60574012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health