Healthcare Provider Details

I. General information

NPI: 1205335197
Provider Name (Legal Business Name): JALEN MICHELLE PRAYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13919 S NORMANDIE AVE
GARDENA CA
90249-2623
US

IV. Provider business mailing address

13919 S NORMANDIE AVE
GARDENA CA
90249-2623
US

V. Phone/Fax

Practice location:
  • Phone: 951-445-1870
  • Fax:
Mailing address:
  • Phone: 951-445-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: