Provider Demographics
NPI:1770871055
Name:WATERS, JENNIFER NORA (MA, ATR, LPCC, LMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NORA
Last Name:WATERS
Suffix:
Gender:F
Credentials:MA, ATR, LPCC, LMHC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NORA
Other - Last Name:MALLOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATR, LPCC, LMHC
Mailing Address - Street 1:3719 TULLY RD STE A1
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1026
Mailing Address - Country:US
Mailing Address - Phone:209-900-1167
Mailing Address - Fax:
Practice Address - Street 1:3719 TULLY RD STE A1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-1026
Practice Address - Country:US
Practice Address - Phone:209-900-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health