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General NPI Number Information
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NPI Number | 1255633517
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Entity Type | Individual
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Provider Name | JENNIFER FARD
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Gender | Female
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Dates
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Enumeration Date | 11/18/2010
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 23041 AVENIDA DE LA CARLOTA
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1511
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Country | US
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Telephone | 949-229-1463
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Fax |
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Provider Business Mailing Address
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Address Line | 1077 PACIFIC COAST HWY # 191
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City | SEAL BEACH
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State | CA
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Zip | 90740-6214
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Country | US
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Telephone | 949-229-1463
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 104661
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License Number State | CA
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