Jefferson Community Counseling Center
Organization Active NPI Community/Behavioral Health Agency · Port Townsend, WA
NPI 1083701015 · NPPES record last updated Feb 7, 2022
Key facts
- NPI
- 1083701015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- JEFFERSON COMMUNITY COUNSELING CENTER
- Practice address
- 884 W Park Ave
Port Townsend, WA 98368-2273 - Phone
- (360) 385-0321
- Fax
- (360) 379-2547
- NPI assigned
- Oct 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Tonya M Ferguson
- Title
- Director of Operations and Complian
- Phone
- (360) 385-0321
Practitioners 176
-
Stanley J Atkins, MSW, SUDP, SWAICL
-
Lance Edward Briggs, PMHNP
-
John Dury, MFT
-
Brenda Gail Francis, DNP PMHNP-BC
-
Jessica Erin Mackinnon, PH.D
-
Karen Elizabeth McKenzie-Alexander, LMHC, LPC
-
Heather Sebastian, ARNP
-
Bernadette Ireland, PMHNP
-
Jane Wanjiru Waweru, PMHNP
-
Jena Leanna Pierce, APRN, PMHNP-BC
-
Travis Scott Albers, PMHNP
-
Ricardo Luis Alves Silva, ARNP
-
Kathryn S Henley, RN, APRN
-
Dana M Milagrosa, MS
-
Jennifer Montjoy, NURSE PRACTITIONER
-
Kelle Gayelena Ronnfeldt, ARNP
-
Heather Anne Blackmore, LMFTA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040311000167 | WA | Part B Supplier - Clinic/Group Practice | 6103715081 |
Receives reassigned benefits from 20 practitioners Practice locations: Port Townsend, WA |
National Provider Directory
Locations
884 W Park Ave
Port Townsend, WA 98368
Phone 3603850321201
686 Lake St
Ste 100
Port Townsend, WA 98368
Interoperability endpoints
- https://api.qualifacts.org/api/fhir/discoverybh/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes | ||
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X |
Addresses
Primary practice location
884 W Park Ave
Port Townsend, WA 98368-2273
Mailing address
PO Box 565
Port Townsend, WA 98368-0565
Phone (360) 385-0321
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7031917 | Medicaid | WA |
Other providers in Port Townsend, WA
- Dolores P, Jacoby
- James O Cunnington DDS
- Claus Henner Janssen
- Christopher Yashpal Jayne
- Joanna Judith Jech
- Jefferson County Fire Protection District 1 Jefferson County
- Jefferson County Fire Protection District 5
- Jefferson County Health Services District No 2
- Jefferson County Public Health
- Jefferson County Public Health
All providers in Port Townsend, WA · Community/Behavioral Health Agency in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.