Provider Demographics
NPI:1003910431
Name:FENBY, JANE (LMHC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:FENBY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13676 W Y RD
Mailing Address - Street 2:
Mailing Address - City:EXELAND
Mailing Address - State:WI
Mailing Address - Zip Code:54835-2240
Mailing Address - Country:US
Mailing Address - Phone:813-924-3136
Mailing Address - Fax:
Practice Address - Street 1:13676 W Y RD STE 303
Practice Address - Street 2:
Practice Address - City:EXELAND
Practice Address - State:WI
Practice Address - Zip Code:54835-2240
Practice Address - Country:US
Practice Address - Phone:813-924-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7601101YM0800X
WI8581-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional