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General NPI Number Information
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NPI Number | 1306997663
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Entity Type | Individual
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Provider Name | JENNIE LEE HANSON MA, MFT INTERN
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Gender | Female
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3100 S HARBOR BLVD SUITE 200
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City | SANTA ANA
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State | CA
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Zip | 92704-6823
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Country | US
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Telephone | 714-966-8656
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Fax |
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Provider Business Mailing Address
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Address Line | 18719 PALM ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6440
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Country | US
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Telephone | 714-968-4361
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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 | IMF 41268
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License Number State | CA
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