Provider Demographics
NPI:1801399936
Name:PITT, JENELLE S
Entity Type:Individual
Prefix:DR
First Name:JENELLE
Middle Name:S
Last Name:PITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1525
Mailing Address - Country:US
Mailing Address - Phone:323-500-3904
Mailing Address - Fax:
Practice Address - Street 1:3406 W ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1525
Practice Address - Country:US
Practice Address - Phone:323-500-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1217101Y00000X
MI6401008480101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor