Provider Demographics
NPI:1417043985
Name:GROVET, JENNIFER LYNN (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GROVET
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:WALTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1915 PLACER ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1734
Mailing Address - Country:US
Mailing Address - Phone:530-223-2822
Mailing Address - Fax:530-223-1917
Practice Address - Street 1:1915 PLACER ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1734
Practice Address - Country:US
Practice Address - Phone:530-223-2822
Practice Address - Fax:530-223-1917
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46596106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 46596OtherBOARD OF BEHAVIORAL SCIENCE
CAIMF 43151OtherINTERN REGIST. NUMBER