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General NPI Number Information
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NPI Number | 1639976368
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Entity Type | Individual
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Provider Name | JENNIFER MACIAS
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 2820 N GLASSFORD HILL RD STE 108
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-2256
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Country | US
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Telephone | 844-385-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 700 MASSACHUSETTS AVE FL 3
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City | CAMBRIDGE
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State | MA
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Zip | 02139-3345
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Country | US
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Telephone | 888-500-2067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LAC-22672
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License Number State | AZ
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