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General NPI Number Information
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NPI Number | 1104573138
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Entity Type | Organization
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Legal Business Name | MENDED HEART FAMILY COUNSELING & TRAUMA RECOVERY CENTER, P.C.
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1968 S COAST HWY STE 5375
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 949-468-2885
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Fax |
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Provider Business Mailing Address
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Address Line | 1968 S COAST HWY STE 5375
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 949-468-2885
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | JENNIFER MORRIS
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Credential | MA
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Telephone | 949-468-2885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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