Healthcare Provider Details

I. General information

NPI: 1376263889
Provider Name (Legal Business Name): JENNIFER ROSE MCGIVERN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S HARBOR BLVD STE 650
ANAHEIM CA
92805-3756
US

IV. Provider business mailing address

222 S HARBOR BLVD STE 650
ANAHEIM CA
92805-3756
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-5646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: