Healthcare Provider Details

I. General information

NPI: 1164652806
Provider Name (Legal Business Name): JENNIFER JOHNSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28765 SINGLE OAK DR STE 100
TEMECULA CA
92590-3661
US

IV. Provider business mailing address

28765 SINGLE OAK DR STE 100
TEMECULA CA
92590-3661
US

V. Phone/Fax

Practice location:
  • Phone: 951-699-4906
  • Fax:
Mailing address:
  • Phone: 951-699-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number111437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: