Provider Demographics
NPI:1952824070
Name:ORDILLO, JENNELLE FAITH (LMFT)
Entity type:Individual
Prefix:
First Name:JENNELLE
Middle Name:FAITH
Last Name:ORDILLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FREMONT AVE STE 250B
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6058
Mailing Address - Country:US
Mailing Address - Phone:408-800-7839
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 250B
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6058
Practice Address - Country:US
Practice Address - Phone:408-800-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
10650503OtherKAISER