Healthcare Provider Details

I. General information

NPI: 1306431465
Provider Name (Legal Business Name): JENNIFER ALLEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1148 ALPINE RD STE 205
WALNUT CREEK CA
94596-4435
US

IV. Provider business mailing address

1148 ALPINE RD STE 205
WALNUT CREEK CA
94596-4435
US

V. Phone/Fax

Practice location:
  • Phone: 925-588-1156
  • Fax:
Mailing address:
  • Phone: 925-588-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number92618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: