Healthcare Provider Details

I. General information

NPI: 1487078317
Provider Name (Legal Business Name): JENNIFER LYNCH MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N VIRGIL AVE # 252
LOS ANGELES CA
90029-2016
US

IV. Provider business mailing address

1110 N VIRGIL AVE # 252
LOS ANGELES CA
90029-2016
US

V. Phone/Fax

Practice location:
  • Phone: 805-795-3344
  • Fax:
Mailing address:
  • Phone: 805-795-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number80620
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number80620
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number80620
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number80620
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number80620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: