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General NPI Number Information
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NPI Number | 1699498600
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Entity Type | Organization
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Legal Business Name | OPEN-HEARTED FAMILY THERAPY INC
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Dates
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Enumeration Date | 09/23/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 7545 IRVINE CENTER DR STE 200
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City | IRVINE
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State | CA
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Zip | 92618-2933
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Country | US
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Telephone | 949-534-2367
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Fax |
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Provider Business Mailing Address
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Address Line | 10 ENSUENO E
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City | IRVINE
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State | CA
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Zip | 92620-1844
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Country | US
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Telephone | 949-300-4590
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE&FAMILY THERAPIST
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Name | JENNIFER ANNE PALISOC
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Credential | LMFT
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Telephone | 949-534-2367
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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 |
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License Number State |
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