Provider Demographics
NPI:1235318668
Name:FENTRESS CALDERON, JENNIFER REBECCA (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:FENTRESS CALDERON
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14624 SHERMAN WAY
Mailing Address - Street 2:SUITE 408
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2241
Mailing Address - Country:US
Mailing Address - Phone:818-778-5406
Mailing Address - Fax:818-787-1860
Practice Address - Street 1:14624 SHERMAN WAY
Practice Address - Street 2:SUITE 408
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2241
Practice Address - Country:US
Practice Address - Phone:818-778-5406
Practice Address - Fax:818-787-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45687106H00000X
CA796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional