Healthcare Provider Details

I. General information

NPI: 1548945884
Provider Name (Legal Business Name): JENNIFER LEE PAGE MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28693 OLD TOWN FRONT ST
TEMECULA CA
92590-2786
US

IV. Provider business mailing address

28693 OLD TOWN FRONT ST STE 300
TEMECULA CA
92590-2789
US

V. Phone/Fax

Practice location:
  • Phone: 951-395-0933
  • Fax:
Mailing address:
  • Phone: 951-395-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: