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General NPI Number Information
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NPI Number | 1598095994
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Entity Type | Individual
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Provider Name | JENNIE S MALEK M.A., MFT
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Gender | Female
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 04/09/2013
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Provider Practice Location Address
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Address Line | 14140 BEACH BLVD SUITE 155
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City | WESTMINSTER
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State | CA
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Zip | 92683-4453
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Country | US
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Telephone | 714-896-7556
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 954
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City | SEAL BEACH
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State | CA
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Zip | 90740-0954
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Country | US
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Telephone | 626-665-2067
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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 | 61189
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License Number State | CA
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