Provider Demographics
NPI:1033674668
Name:SMITH, JENNA (MFTC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10524 W 106TH WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3607
Mailing Address - Country:US
Mailing Address - Phone:712-308-1218
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD STE 219C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6145
Practice Address - Country:US
Practice Address - Phone:303-552-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist