Provider Demographics
NPI:1043431752
Name:JENTOFT, SUSAN YOUNG (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:YOUNG
Last Name:JENTOFT
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-9680
Mailing Address - Country:US
Mailing Address - Phone:601-479-2345
Mailing Address - Fax:205-459-2629
Practice Address - Street 1:5410 WINDSOR RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-9680
Practice Address - Country:US
Practice Address - Phone:601-479-2345
Practice Address - Fax:205-459-2629
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0666101YP2500X
AL2000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional