Provider Demographics
NPI:1013244102
Name:GLASSCOCK, JENNA (MA, MFT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GLASSCOCK
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-409-5040
Mailing Address - Fax:707-221-8970
Practice Address - Street 1:331 E REDWOOD AVE
Practice Address - Street 2:STE E
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-734-9066
Practice Address - Fax:844-388-6167
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA92510106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health