Provider Demographics
NPI:1780996207
Name:TEGROTENHUIS, JENNY (MA, MED, LMHC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TEGROTENHUIS
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8813 W GRAND RONDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1096
Mailing Address - Country:US
Mailing Address - Phone:509-438-5955
Mailing Address - Fax:
Practice Address - Street 1:8797 GAGE BLVD.
Practice Address - Street 2:SUITE NUMBER 203
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1096
Practice Address - Country:US
Practice Address - Phone:509-438-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60160841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health