Provider Demographics
NPI:1548570245
Name:HUSE, JENNIFER LYNN (MFT-I)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:HUSE
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 E FLAMINGO RD
Mailing Address - Street 2:SUITE 324
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5003
Mailing Address - Country:US
Mailing Address - Phone:702-449-4095
Mailing Address - Fax:702-749-3202
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:SUITE 324
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-449-4095
Practice Address - Fax:702-749-3202
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist