Provider Demographics
NPI:1497269559
Name:AUTRY, JENNIFER (CADC-I)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:AUTRY
Suffix:
Gender:F
Credentials:CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SAFE HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1137
Mailing Address - Country:US
Mailing Address - Phone:775-787-9441
Mailing Address - Fax:775-787-9445
Practice Address - Street 1:3700 SAFE HARBOR WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1137
Practice Address - Country:US
Practice Address - Phone:775-787-9441
Practice Address - Fax:775-787-9445
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
02168-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)