Provider Demographics
NPI:1598423238
Name:JENNI BATALUCCO, MFT LLC
Entity Type:Organization
Organization Name:JENNI BATALUCCO, MFT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BATALUCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:808-975-9674
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:KOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96756-1358
Mailing Address - Country:US
Mailing Address - Phone:858-414-0096
Mailing Address - Fax:
Practice Address - Street 1:3424A POIPU RD
Practice Address - Street 2:
Practice Address - City:KOLOA
Practice Address - State:HI
Practice Address - Zip Code:96756-9522
Practice Address - Country:US
Practice Address - Phone:858-414-0096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)