Healthcare Provider Details

I. General information

NPI: 1942144688
Provider Name (Legal Business Name): JENNIFER EMBLOM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNY EMBLOM LMFT

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 BROCKWAY RD STE 303
TRUCKEE CA
96161-2220
US

IV. Provider business mailing address

194 GOLD FLAT RD
NEVADA CITY CA
95959-3237
US

V. Phone/Fax

Practice location:
  • Phone: 310-795-5366
  • Fax:
Mailing address:
  • Phone: 310-795-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: