Healthcare Provider Details

I. General information

NPI: 1326374323
Provider Name (Legal Business Name): JENNIFER MARY BEHOTEGUY EDD, LCSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARY DUBOIS LCSW

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY PKWY W STE 400
ORANGE CA
92868-2941
US

IV. Provider business mailing address

750 THE CITY DR S STE 225
ORANGE CA
92868-4976
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-7725
  • Fax:
Mailing address:
  • Phone: 714-949-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 29567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: