Provider Demographics
NPI:1316206758
Name:LEDESMA, JENNY LYN L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNY LYN
Middle Name:L
Last Name:LEDESMA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 PAINTED MORNING AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-3645
Mailing Address - Country:US
Mailing Address - Phone:702-300-5128
Mailing Address - Fax:
Practice Address - Street 1:3465 W CRAIG RD STE D
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5121
Practice Address - Country:US
Practice Address - Phone:702-300-5128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NVMI0348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist