Provider Demographics
NPI:1679748156
Name:CONWAY, JENNIFER HOLM (LMFT 90715)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HOLM
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LMFT 90715
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 BUSINESS PARK S
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0721
Mailing Address - Country:US
Mailing Address - Phone:661-327-5100
Mailing Address - Fax:
Practice Address - Street 1:5401 BUSINESS PARK S
Practice Address - Street 2:SUITE 208
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0721
Practice Address - Country:US
Practice Address - Phone:661-327-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAIMF 62030106H00000X
CA90715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)