Healthcare Provider Details

I. General information

NPI: 1508694977
Provider Name (Legal Business Name): JENNA MARIE CANTU LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 BARRANCA PKWY
IRVINE CA
92604-4652
US

IV. Provider business mailing address

2390 CRENSHAW BLVD STE E
TORRANCE CA
90501-3348
US

V. Phone/Fax

Practice location:
  • Phone: 949-936-5287
  • Fax:
Mailing address:
  • Phone: 424-282-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: