Provider Demographics
NPI:1730964123
Name:AQUINO, JENESSE RAE QUAN (LMHCA)
Entity type:Individual
Prefix:
First Name:JENESSE
Middle Name:RAE QUAN
Last Name:AQUINO
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 BRIDGEPORT WAY W STE C
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4328
Mailing Address - Country:US
Mailing Address - Phone:808-517-1590
Mailing Address - Fax:
Practice Address - Street 1:4109 BRIDGEPORT WAY W STE C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4328
Practice Address - Country:US
Practice Address - Phone:808-517-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61472064101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor