Provider Demographics
NPI:1730834110
Name:L JENAE MACNAUGHTON
Entity type:Organization
Organization Name:L JENAE MACNAUGHTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:L JENAE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMHC
Authorized Official - Phone:844-414-6737
Mailing Address - Street 1:PO BOX 91196
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-1196
Mailing Address - Country:US
Mailing Address - Phone:844-414-6737
Mailing Address - Fax:877-560-9702
Practice Address - Street 1:1601 W NORTHERN LIGHTS BLVD STE 91196
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3315
Practice Address - Country:US
Practice Address - Phone:844-414-6737
Practice Address - Fax:877-560-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty