Provider Demographics
NPI:1447668306
Name:WILLFORD, JENNA (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WILLFORD
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 ALDERSGATE CT
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5822
Mailing Address - Country:US
Mailing Address - Phone:530-545-9502
Mailing Address - Fax:
Practice Address - Street 1:2533 N CARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0242
Practice Address - Country:US
Practice Address - Phone:775-684-1945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12197-C1041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor