Healthcare Provider Details

I. General information

NPI: 1619883329
Provider Name (Legal Business Name): JENNIFER WALTERS FAMILY COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S ORANGE GROVE BLVD
PASADENA CA
91105-1705
US

IV. Provider business mailing address

210 S ORANGE GROVE BLVD
PASADENA CA
91105-1705
US

V. Phone/Fax

Practice location:
  • Phone: 323-509-4638
  • Fax:
Mailing address:
  • Phone: 323-509-4638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER A WALTERS
Title or Position: OWNER
Credential: LMFT
Phone: 323-509-4638