| Jefferson Community Counseling Center | |
|
884 W Park Ave Port Townsend WA 98368-2273 | |
| (360) 385-0321 | |
| (360) 379-2547 |
| Full Name | Jefferson Community Counseling Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 884 W Park Ave, Port Townsend, Washington |
| Authorized Official Name and Position | Tonya M Ferguson (DIRECTOR OF OPERATIONS AND COMPLIAN) |
| Authorized Official Contact | 3603850321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson Community Counseling Center Po Box 565 Port Townsend WA 98368-0565 Ph: (360) 385-0321 | Jefferson Community Counseling Center 884 W Park Ave Port Townsend WA 98368-2273 Ph: (360) 385-0321 |
| NPI Number | 1083701015 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 02/07/2022 |
| Certification Date | 02/07/2022 |
| Medicare PECOS PAC ID | 6103715081 |
|---|---|
| Medicare Enrollment ID | O20040311000167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083701015 | NPI | - | NPPES |
| 7031917 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Jessica Erin Mackinnon |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942668793 PECOS PAC ID: 5395044838 Enrollment ID: I20160620000636 |
| Provider Name | Kathryn S Henley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538175211 PECOS PAC ID: 7012915309 Enrollment ID: I20180109001506 |
| Provider Name | Kelle Gayelena Ronnfeldt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700349461 PECOS PAC ID: 8729311634 Enrollment ID: I20190607002465 |
| Provider Name | Cynthia Ann Langston |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215458666 PECOS PAC ID: 5890183651 Enrollment ID: I20211027001724 |
| Provider Name | Travis S Albers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467148387 PECOS PAC ID: 0042677189 Enrollment ID: I20230606001546 |
| Provider Name | Ricardo Alves Silva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346814035 PECOS PAC ID: 1850751660 Enrollment ID: I20230712001059 |
| Provider Name | Dana M Milagrosa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1083897037 PECOS PAC ID: 9234574369 Enrollment ID: I20240228004286 |
| Provider Name | John Dury |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811161516 PECOS PAC ID: 4385081744 Enrollment ID: I20240320002993 |
| Provider Name | Lissa A Wick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649850389 PECOS PAC ID: 0840638326 Enrollment ID: I20240403000660 |
Opas P. C. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1334 Lawrence St, Port Townsend, WA 98368 Phone: 360-385-4843 Fax: 360-379-1441 | |
Center For Positive Change Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1136 Water St Ste 105, Port Townsend, WA 98368 Phone: 360-385-1030 Fax: 775-243-9945 | |
Believe In Recovery Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 Taylor St, Suite 20, Port Townsend, WA 98368 Phone: 360-385-1258 Fax: 360-385-1258 | |
Madrona Institute Of Washington Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 884 W Park Ave, Port Townsend, WA 98368 Phone: 360-385-0321 Fax: 360-385-3944 | |
Safe Harbor Recovery Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 686 Lake St Ste 400, Port Townsend, WA 98368 Phone: 360-385-3866 | |
Olympic Aba Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 4645 Bell Street, Port Townsend, WA 98368 Phone: 360-643-0034 Fax: 360-208-0665 |