Jacqueline Licea

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFTA.MG.61408457 Issued in WA

Practice address

6845 S Alder St
Tacoma, WA 98409-5213

Phone

(253) 267-0085

NPI assigned

Jan 3, 2020

Last updated

Mar 4, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Twin Lakes Counseling, PLLC

  dba Twin Lakes Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Federal Way, WA
  • NPI 1053828814

  Marriage & Family Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677888000000",
    "number": "1831738160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 111780",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984111780",
            "telephone_number": "253-267-0085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6845 S ALDER ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984095213",
            "telephone_number": "253-267-0085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICEA",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-03",
        "last_updated": "2023-03-04",
        "certification_date": "2023-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WA",
            "license": "MFTA.MG.61408457",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jackielicea@designatedhealercounseling.com",
            "affiliation": "Y",
            "affiliationName": "Designated Healer Counseling",
            "address_1": "6845 S Alder St",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984095213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Liberation Therapy PLLC
• Liberty Dialysis - Laredo Acutes LLC
• Liberty Dialysis - Sacramento LLC (Liberty Dialysis - Manzanita)
• Tamar Libicki
• Matthew Libid, CRNA
• Alexandrea Ann Liddell, LPN
• Donna May Lidren, PHD
• Anthony Ray Liedtke, RPH
• Elizabeth A Lien, M.D.
• Teri Jo Lientz, P.T., A.T.C.

• Marriage & Family Therapist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Marriage & Family Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.