Organization
LAKE SACAJAWEA MIND AND FAMILY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANIEZKA JENISSEN (OWNER)
(360) 984-9018
Entity
Organization
Contact information
Practice address
1329 BROADWAY ST STE 204, LONGVIEW, WA 98632-3731
(360) 984-9018
Mailing address
1329 BROADWAY ST STE 204, LONGVIEW, WA 98632-3731
(206) 331-6660
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
08/08/2025
Last updated
05/06/2026
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