Provider Demographics
NPI:1497298806
Name:MATERN, JENNY (MMFT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MATERN
Suffix:
Gender:F
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 MARYLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5037
Mailing Address - Country:US
Mailing Address - Phone:615-604-8493
Mailing Address - Fax:
Practice Address - Street 1:5409 MARYLAND WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5037
Practice Address - Country:US
Practice Address - Phone:615-604-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist