Provider Demographics
NPI:1922477660
Name:RENFRO, JESSICA LORRAINE (LMHCA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:RENFRO
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LORRAINE
Other - Last Name:RENFRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1809 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-7610
Mailing Address - Country:US
Mailing Address - Phone:360-379-5109
Mailing Address - Fax:
Practice Address - Street 1:1809 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-7610
Practice Address - Country:US
Practice Address - Phone:360-379-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60582821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health