Provider Demographics
NPI:1376251678
Name:WAHLEN, JEANNETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:
Last Name:WAHLEN
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:PO BOX 1573
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-1573
Mailing Address - Country:US
Mailing Address - Phone:530-520-6364
Mailing Address - Fax:
Practice Address - Street 1:1045 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2812
Practice Address - Country:US
Practice Address - Phone:920-786-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health