Provider Demographics
NPI:1982369740
Name:JENNIFER MARIE HUGHEY
Entity Type:Organization
Organization Name:JENNIFER MARIE HUGHEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:909-294-8833
Mailing Address - Street 1:4010 MERRILL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4010 MERRILL AVE STE C
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2216
Practice Address - Country:US
Practice Address - Phone:909-294-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA117168OtherLICENSE