Healthcare Provider Details

I. General information

NPI: 1821112749
Provider Name (Legal Business Name): JEANNE C OBRYAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20371 IRVINE AVE STE A160
SANTA ANA CA
92707-5651
US

IV. Provider business mailing address

20371 IRVINE AVE STE A160
SANTA ANA CA
92707-5651
US

V. Phone/Fax

Practice location:
  • Phone: 714-540-5010
  • Fax: 714-540-5020
Mailing address:
  • Phone: 714-540-5010
  • Fax: 714-540-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC16005
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: