Provider Demographics
NPI:1982340519
Name:MARLOWE, JENNIFER (MS, LASAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARLOWE
Suffix:
Gender:F
Credentials:MS, LASAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MARLOWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BHT, CCTS-I
Mailing Address - Street 1:3101 S MELANIE DRIVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:928-304-0534
Mailing Address - Fax:
Practice Address - Street 1:2197 S 4TH AVENUE STE 202
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
AZ7779T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health