Healthcare Provider Details

I. General information

NPI: 1154912384
Provider Name (Legal Business Name): JENNIFER MINKYUNG CHA LMFT, PSYD STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIN KYUNG CHA

II. Dates (important events)

Enumeration Date: 01/30/2021
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

8260 SWEETWATER CREEK WAY
LAS VEGAS NV
89113-4686
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 213-200-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: