Provider Demographics
NPI:1679156665
Name:BETHANCOURT, JENNA (MFT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BETHANCOURT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3576 RIOJO WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6966
Mailing Address - Country:US
Mailing Address - Phone:916-812-8458
Mailing Address - Fax:
Practice Address - Street 1:4221 NORTHGATE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1227
Practice Address - Country:US
Practice Address - Phone:916-812-8458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA125147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health