Healthcare Provider Details

I. General information

NPI: 1073670782
Provider Name (Legal Business Name): JENNIFER LEE LHMC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER TUFTE

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PARK PL NE STE G
CEDAR RAPIDS IA
52402
US

IV. Provider business mailing address

1231 PARK PL NE STE G
CEDAR RAPIDS IA
52402-2013
US

V. Phone/Fax

Practice location:
  • Phone: 319-389-9795
  • Fax: 319-343-1089
Mailing address:
  • Phone: 319-389-9795
  • Fax: 319-343-1089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00986
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: