Healthcare Provider Details

I. General information

NPI: 1326176306
Provider Name (Legal Business Name): JEN YIP M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEN YIP MA, MFT

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WINCHESTER BLVD., SUITE 214
CAMPTBELL CA
95008-2631
US

IV. Provider business mailing address

1255 LINCOLN ST. #21 APT/SUITE 21
SANTA CLARA CA
95050-6038
US

V. Phone/Fax

Practice location:
  • Phone: 408-703-4241
  • Fax: 408-703-4241
Mailing address:
  • Phone: 408-703-4241
  • Fax: 408-703-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC47767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: