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General NPI Number Information
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NPI Number | 1831219773
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Entity Type | Organization
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Legal Business Name | JENNY ELLINGSEN DBA GENESIS GROUP
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3150 EL CAMINO REAL SUITE E
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City | CARLSBAD
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State | CA
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Zip | 92008-2110
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Country | US
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Telephone | 760-729-5705
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Fax | 760-632-0223
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Provider Business Mailing Address
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Address Line | 3150 EL CAMINO REAL SUITE E
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City | CARLSBAD
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State | CA
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Zip | 92008-2110
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Country | US
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Telephone | 760-729-5705
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Fax | 760-632-0223
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JENNY RODELANDER ELLINGSEN
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Credential | MS
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Telephone | 760-729-5705
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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 | CA# MFC19117
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License Number State | CA
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