Provider Demographics
NPI:1154447290
Name:JENIS ASSOCIATES, LLC
Entity type:Organization
Organization Name:JENIS ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BEATTY-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LPC, CTNC,CMHIMP
Authorized Official - Phone:480-775-3528
Mailing Address - Street 1:4111 E VALLEY AUTO DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4605
Mailing Address - Country:US
Mailing Address - Phone:480-775-3528
Mailing Address - Fax:480-813-2987
Practice Address - Street 1:603 N ROSEMONT CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6427
Practice Address - Country:US
Practice Address - Phone:480-775-3528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7434358OtherAETNA PROVIDER ID
AZ760718268OtherMAGELLAN PROVIDER ID
AZ896467OtherAHCCCS PROVIDER ID
AZ760718268OtherAFMC PROVIDER ID