Provider Demographics
NPI:1477339331
Name:DOUCETTE, JENAH ELIZABETH (AMFT)
Entity type:Individual
Prefix:
First Name:JENAH
Middle Name:ELIZABETH
Last Name:DOUCETTE
Suffix:
Gender:X
Credentials:AMFT
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:DOUCETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT
Mailing Address - Street 1:776 S STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5833
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:707-463-4917
Practice Address - Street 1:631 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3847
Practice Address - Country:US
Practice Address - Phone:650-367-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA151549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner