Healthcare Provider Details

I. General information

NPI: 1518098227
Provider Name (Legal Business Name): JENNIFER ELAINE SEIDEL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 N FRESNO ST
FRESNO CA
93703-1123
US

IV. Provider business mailing address

3433 W SHAW AVE STE 107
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2043
  • Fax: 559-688-1304
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 44129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: