Provider Demographics
NPI:1427577337
Name:FAKHOURY, JENNA JAMAL (LPC, MA, NCC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:JAMAL
Last Name:FAKHOURY
Suffix:
Gender:
Credentials:LPC, MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 ORDELIA LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12151-1730
Mailing Address - Country:US
Mailing Address - Phone:720-588-2168
Mailing Address - Fax:
Practice Address - Street 1:77 ORDELIA LN
Practice Address - Street 2:
Practice Address - City:ROUND LAKE
Practice Address - State:NY
Practice Address - Zip Code:12151-1730
Practice Address - Country:US
Practice Address - Phone:720-588-2168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25302101YM0800X
NY015255101YM0800X
NJ37PC01012400101YP2500X
WI6490-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health