Provider Demographics
NPI:1639766157
Name:ST MARS, JENNA L (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:ST MARS
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-9680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TWP
Practice Address - State:PA
Practice Address - Zip Code:15012-9680
Practice Address - Country:US
Practice Address - Phone:724-417-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional