Active NPI
Jenelle Bartlett
- Behavior Analyst
- Covington, WA
National Provider Identifier
1134559859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 27023 164TH Ave SE
Covington, WA 98042-8241 - Phone
- (253) 639-7146
- Fax
- (253) 639-7145
- NPI assigned
- Nov 15, 2013
- Last updated
- Sep 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60416007 | WA | |
| Behavior Analyst | 103K00000X | NU | Primary |
Addresses
Primary practice location
27023 164TH Ave SE
Covington, WA 98042-8241
Mailing address
31621 32ND Ave SW
Federal Way, WA 98023-2252
Phone (520) 371-1107
Other practice location 1
8815 S Tacoma Way
Suite 122
Lakewood, WA 98499-4587
Phone (253) 682-0320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60416007 | WA | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mindsource Center, LLC | Past | Accepting new patients | |
| Imagine Behavioral & Developmental Services | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Spokane, WA
- NPI 1619211042
Behavior Analyst
-
- Community/Behavioral Health Agency
- Covington, WA
- NPI 1477978849
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630540800000",
"number": "1134559859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31621 32ND AVE SW",
"city": "FEDERAL WAY",
"state": "WA",
"postal_code": "980232252",
"telephone_number": "520-371-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27023 164TH AVE SE",
"city": "COVINGTON",
"state": "WA",
"postal_code": "980428241",
"telephone_number": "253-639-7146",
"fax_number": "253-639-7145"
}
],
"practiceLocations": [
{
"address_1": "8815 S Tacoma Way",
"address_2": "Suite 122",
"address_purpose": "LOCATION",
"city": "Lakewood",
"state": "WA",
"postal_code": "984994587",
"country_code": "US",
"telephone_number": "253-682-0320",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BARTLETT",
"first_name": "JENELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-15",
"last_updated": "2021-09-02",
"certification_date": "2021-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60416007",
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Covington, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.