Healthcare Provider Details

I. General information

NPI: 1497408660
Provider Name (Legal Business Name): NICOLE C. ZENS, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25302 PERCH DR
DANA POINT CA
92629-2052
US

IV. Provider business mailing address

24551 DEL PRADO
DANA POINT CA
92629-6200
US

V. Phone/Fax

Practice location:
  • Phone: 949-616-6598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE ZENS
Title or Position: OWNER
Credential: MS
Phone: 949-616-6598