Provider Demographics
NPI:1932414158
Name:WENTZ, JENNIFER (MFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:WENTZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MCKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:101 GREGORY LN
Mailing Address - Street 2:SUITE 33
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4982
Mailing Address - Country:US
Mailing Address - Phone:925-827-9876
Mailing Address - Fax:925-827-1008
Practice Address - Street 1:101 GREGORY LN
Practice Address - Street 2:SUITE 33
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4982
Practice Address - Country:US
Practice Address - Phone:925-827-9876
Practice Address - Fax:925-827-1008
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist