Provider Demographics
NPI:1962696849
Name:JETER, JENNIFER PATRICIA (MFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PATRICIA
Last Name:JETER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 2ND AVE
Mailing Address - Street 2:SUITE 56-A1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5636
Mailing Address - Country:US
Mailing Address - Phone:619-813-4124
Mailing Address - Fax:619-787-9707
Practice Address - Street 1:3356 2ND AVE
Practice Address - Street 2:SUITE 56-A1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5636
Practice Address - Country:US
Practice Address - Phone:619-813-4124
Practice Address - Fax:619-787-9707
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37592106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist