Healthcare Provider Details

I. General information

NPI: 1861164477
Provider Name (Legal Business Name): JENNIFER MARIE ICE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 W WARM SPRINGS RD STE 110
HENDERSON NV
89014-7367
US

IV. Provider business mailing address

1489 W WARM SPRINGS RD STE 110
HENDERSON NV
89014-7367
US

V. Phone/Fax

Practice location:
  • Phone: 702-363-7284
  • Fax:
Mailing address:
  • Phone: 630-999-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4071
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: