Provider Demographics
NPI:1013253889
Name:TICHENOR, JENNIFER L (MA LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 COUNTY ROAD D E
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5357
Mailing Address - Country:US
Mailing Address - Phone:651-338-9816
Mailing Address - Fax:651-305-0277
Practice Address - Street 1:2103 COUNTY ROAD D E
Practice Address - Street 2:SUITE A
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5357
Practice Address - Country:US
Practice Address - Phone:651-338-9816
Practice Address - Fax:651-305-0277
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013253889Medicare UPIN