Basic Information
| Provider Information | |||||||||
| NPI: | 1710013917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | SUZANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WINTHER | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | SUZANNE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2550 W. CLINTON AVE. | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592647521 | ||||||||
| FaxNumber: | 5594410340 | ||||||||
| Practice Location | |||||||||
| Address1: | 43305 CRYSTAL SPRINGS WAY | ||||||||
| Address2: | |||||||||
| City: | COARSEGOLD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936149694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593135632 | ||||||||
| FaxNumber: | 5596424597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 02/02/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 41576 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.