Provider Demographics
NPI:1386361608
Name:CISNEROS, JENNIFER JANE (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JANE
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12566 S WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93725-9127
Mailing Address - Country:US
Mailing Address - Phone:559-313-0771
Mailing Address - Fax:
Practice Address - Street 1:7257 N MAPLE AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0167
Practice Address - Country:US
Practice Address - Phone:559-440-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health