Provider Demographics
NPI:1821606187
Name:VAN NES, JENNILEE KESHET (MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JENNILEE
Middle Name:KESHET
Last Name:VAN NES
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7518 KELLEY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-1123
Mailing Address - Country:US
Mailing Address - Phone:209-200-0650
Mailing Address - Fax:
Practice Address - Street 1:5651 N PERSHING AVE STE C6
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4947
Practice Address - Country:US
Practice Address - Phone:209-200-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health