Provider Demographics
NPI:1790700730
Name:KISER, JENNIFER M (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:KISER
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:KISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 S JONES BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5607
Mailing Address - Country:US
Mailing Address - Phone:714-271-0622
Mailing Address - Fax:
Practice Address - Street 1:2675 S JONES BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5607
Practice Address - Country:US
Practice Address - Phone:702-951-9751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37922106H00000X
NV2734-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist