Provider Demographics
NPI:1669280822
Name:REED, JENNA MICHELLE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:REED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CHANDLER HEIGHTS RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5065
Mailing Address - Country:US
Mailing Address - Phone:480-687-1665
Mailing Address - Fax:
Practice Address - Street 1:208 W CHANDLER HEIGHTS RD # 102
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5065
Practice Address - Country:US
Practice Address - Phone:480-687-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-23264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health