MEDICARE: JENNA NICOLE PETTIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	143662	CA
2	101YP2500X	Professional Counselor	15425	CA

General Provider Information

NPI Number	:	1427778661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA NICOLE PETTIT

Provider Business Mailing Address
First Line	:	1535 N BROADWAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-2015
Country	:	US
Telephone Number	:	800-659-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 N BROADWAY
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-2015
Country	:	US
Telephone Number	:	800-659-1522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	05/07/2026

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Directions to “ JENNA NICOLE PETTIT ” Practice Location

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