Provider Demographics
NPI:1194891572
Name:JENROW, ATEFEH E (MA LLP LPC)
Entity type:Individual
Prefix:
First Name:ATEFEH
Middle Name:E
Last Name:JENROW
Suffix:
Gender:F
Credentials:MA LLP LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20300 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4105
Mailing Address - Country:US
Mailing Address - Phone:248-559-8190
Mailing Address - Fax:
Practice Address - Street 1:200 DIVERSION ST
Practice Address - Street 2:SUITE 10A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2267
Practice Address - Country:US
Practice Address - Phone:248-608-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007329101Y00000X
MI6301011082103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor