Basic Information
| Provider Information | |||||||||
| NPI: | 1316096472 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENET | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST | ||||||||
| Address2: | SEATTLE MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
| FaxNumber: | 2063022210 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 5TH AVE | ||||||||
| Address2: | MS KCF-PH-0600 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062961187 | ||||||||
| FaxNumber: | 2062964035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH00010625 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.