Provider Information for 1043431752
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Mrs. SUSAN YOUNG JENTOFT M.S., LPC, NCC
Sex: Female
NPI: 1043431752
Last Updated: 2025-02-12
Certification Date: 2025-02-12
Certification Date: 2025-02-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1043431752 | ||||||||||||
| Enumeration Date | 2007-05-01 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 5410 WINDSOR RD MERIDIAN, MS 39305-9680 United States Phone: 601-479-2345 | Fax:205-459-2629 | ||||||||||||
| Primary Practice Address | 5410 WINDSOR RD MERIDIAN, MS 39305-9680 United States Phone: 601-479-2345 | Fax:205-459-2629 | ||||||||||||
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