Provider Demographics
NPI:1720809502
Name:AVENDANO, JENNIFER EMILIA (MS, AMFT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:EMILIA
Last Name:AVENDANO
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL
Practice Address - Street 2:#215
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist