Provider Demographics
NPI:1558492629
Name:CUNNINGHAM, JENNIE K (MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:K
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:3101 ACORN GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9521
Mailing Address - Country:US
Mailing Address - Phone:858-336-5190
Mailing Address - Fax:
Practice Address - Street 1:3101 ACORN GLEN WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9521
Practice Address - Country:US
Practice Address - Phone:858-336-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46960106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist