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General NPI Number Information
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NPI Number | 1235553397
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Entity Type | Individual
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Provider Name | JENNIFER LOPEZ LMFT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 1430 E COOLEY DR STE 240
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City | COLTON
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State | CA
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Zip | 92324-3936
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Country | US
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Telephone | 800-675-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 5172 ARLINGTON AVE # 4221
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City | RIVERSIDE
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State | CA
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Zip | 92504-2686
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Country | US
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Telephone | 951-858-8753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 130933
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License Number State | CA
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