MEDICARE: JENNA BETHANCOURT MFT

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	101YM0800X	Mental Health Counselor	125147	CA

General Provider Information

NPI Number	:	1679156665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA BETHANCOURT MFT

Provider Business Mailing Address
First Line	:	3576 RIOJO WAY
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-6966
Country	:	US
Telephone Number	:	916-812-8458
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 NORTHGATE BLVD STE 3
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1227
Country	:	US
Telephone Number	:	916-812-8458
Fax Number	:

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

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	02/05/2023

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