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General NPI Number Information
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NPI Number | 1427320605
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Entity Type | Organization
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Legal Business Name | JENNIFER LUNDY FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 02/02/2012
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 5480 BALTIMORE DR STE 250
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City | LA MESA
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State | CA
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Zip | 91942-2066
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Country | US
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Telephone | 619-733-6414
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Fax | 619-303-3306
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Provider Business Mailing Address
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Address Line | 5480 BALTIMORE DR STE 250
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City | LA MESA
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State | CA
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Zip | 91942-2066
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Country | US
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Telephone | 619-733-6414
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Fax | 619-303-3306
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LYNN LUNDY-AGUERRE
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Credential | MFT
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Telephone | 619-733-6414
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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 | 42025
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21402
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License Number State | CA
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