Provider Demographics
NPI:1346836772
Name:POHOT, JENNIFER SUSAN (MSPSY)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUSAN
Last Name:POHOT
Suffix:
Gender:F
Credentials:MSPSY
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SUSAN
Other - Last Name:POHOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:620 CHAPARRAL
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1318
Mailing Address - Country:US
Mailing Address - Phone:928-231-3361
Mailing Address - Fax:
Practice Address - Street 1:620 CHAPARRAL
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1318
Practice Address - Country:US
Practice Address - Phone:928-231-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000OtherBEHAVIORAL COACH