Provider Demographics
NPI:1366175192
Name:MAHAFFEY, JENNIFER (LMHCA, SUDPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:LMHCA, SUDPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:STUDSTRUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3224 CROSBY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7820
Mailing Address - Country:US
Mailing Address - Phone:808-221-1960
Mailing Address - Fax:
Practice Address - Street 1:3773 MARTIN WAY E STE 107
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4400
Practice Address - Country:US
Practice Address - Phone:360-688-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61345268101YA0400X
WAMC61294065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)