Provider Demographics
NPI:1760464861
Name:FOREMAN, JEANINE L (LPC)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:L
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 E SPOUSE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6184
Mailing Address - Country:US
Mailing Address - Phone:928-759-0033
Mailing Address - Fax:928-759-0066
Practice Address - Street 1:8030 E SPOUSE DR
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6184
Practice Address - Country:US
Practice Address - Phone:928-759-0033
Practice Address - Fax:928-759-0066
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC10878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional