Provider Demographics
NPI:1477710259
Name:WEST, JENNA
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:TEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 ARBORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-5737
Mailing Address - Country:US
Mailing Address - Phone:910-658-6226
Mailing Address - Fax:
Practice Address - Street 1:2404 ARBORWOOD DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-5737
Practice Address - Country:US
Practice Address - Phone:910-658-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF63345106H00000X
CA96743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist