1417113341 NPI number — MRS. JENNA ELISSA EISENBERG LMFT

Table of content: MRS. JENNA ELISSA EISENBERG LMFT (NPI 1417113341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417113341 NPI number — MRS. JENNA ELISSA EISENBERG LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EISENBERG
Provider First Name:
JENNA
Provider Middle Name:
ELISSA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EISENBERG
Provider Other First Name:
JENA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417113341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5650 GREENWOOD PLAZA BLVD
Provider Second Line Business Mailing Address:
# 225K
Provider Business Mailing Address City Name:
GREENWOOD VILLAGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80111-2307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-927-8939
Provider Business Mailing Address Fax Number:
720-379-3076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5650 GREENWOOD PLAZA BLVD
Provider Second Line Business Practice Location Address:
# 225K
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-927-8939
Provider Business Practice Location Address Fax Number:
720-379-3076
Provider Enumeration Date:
07/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT -898 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 46807 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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