Individual
JENNIFER MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW ASSOCIATE
Contact information
Practice address
12 S 8TH ST, YAKIMA, WA 98901-3020
(509) 454-4143
(509) 454-4115
Mailing address
PO BOX 2605, YAKIMA, WA 98907-2605
(509) 454-4143
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
SC61578433
WA
104100000X
Social Worker
—
WA
171M00000X
Case Manager/Care Coordinator
SC61578433
WA
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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