Healthcare Provider Details

I. General information

NPI: 1427294156
Provider Name (Legal Business Name): MISS JENNIFER LEE PAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2183 FAIRVIEW RD SUITE 100
COSTA MESA CA
92627-5663
US

IV. Provider business mailing address

6831 PRESIDIO DR
HUNTINGTON BEACH CA
92648-3065
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-5440
  • Fax: 714-515-5444
Mailing address:
  • Phone: 714-371-5462
  • Fax: 714-969-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: