Provider Demographics
NPI:1003587635
Name:MASTERS, JENNA (MA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 TUSCAN VALLEY ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2505
Mailing Address - Country:US
Mailing Address - Phone:314-827-8732
Mailing Address - Fax:
Practice Address - Street 1:140 CLIFF CAVE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3646
Practice Address - Country:US
Practice Address - Phone:314-827-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021030439101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty