Provider Demographics
NPI:1235843731
Name:MUCH, JENNIFER (MFTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MUCH
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 BEACH DR E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8111
Mailing Address - Country:US
Mailing Address - Phone:360-473-7850
Mailing Address - Fax:
Practice Address - Street 1:2621 BEACH DR E
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-8111
Practice Address - Country:US
Practice Address - Phone:360-473-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG-61231134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist