Healthcare Provider Details

I. General information

NPI: 1699491506
Provider Name (Legal Business Name): JENNIFER ELIZABETH CORNELL LMFT159945
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 HONPIE RD
PLACERVILLE CA
95667-8682
US

IV. Provider business mailing address

5168 HONPIE RD
PLACERVILLE CA
95667-8682
US

V. Phone/Fax

Practice location:
  • Phone: 530-387-4975
  • Fax:
Mailing address:
  • Phone: 415-279-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT159945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: