Provider Demographics
NPI:1548512676
Name:LUBANSKI, JENNIFER J (LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:LUBANSKI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1911
Mailing Address - Country:US
Mailing Address - Phone:425-891-2695
Mailing Address - Fax:877-206-8818
Practice Address - Street 1:416 N PEARL ST OFC 4
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3228
Practice Address - Country:US
Practice Address - Phone:425-891-2695
Practice Address - Fax:877-206-8818
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-13
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X, 101Y00000X, 101YP1600X, 251C00000X
WALH60646334101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2094502Medicaid
WA2108321Medicaid