Healthcare Provider Details

I. General information

NPI: 1902692940
Provider Name (Legal Business Name): JENNIFER LENTENBRINK PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 LA MESA BLVD STE 110
LA MESA CA
91942-0361
US

IV. Provider business mailing address

8080 LA MESA BLVD STE 110
LA MESA CA
91942-0361
US

V. Phone/Fax

Practice location:
  • Phone: 619-940-5533
  • Fax: 858-923-0213
Mailing address:
  • Phone: 619-940-5533
  • Fax: 858-923-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LENTENBRINK
Title or Position: CEO
Credential: PHD
Phone: 269-998-4365