Healthcare Provider Details

I. General information

NPI: 1235262361
Provider Name (Legal Business Name): JENAE MORGEN HEITKAMP M.A. M.F.T.I.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 QUAIL ST
NEWPORT BEACH CA
92660-2730
US

IV. Provider business mailing address

11861 WINTON ST
GARDEN GROVE CA
92845-1123
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-7120
  • Fax:
Mailing address:
  • Phone: 310-733-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF45877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: