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General NPI Number Information
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NPI Number | 1841706017
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Entity Type | Individual
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Provider Name | JENNIFER ANNE PALISOC LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/23/2017
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Last Update Date | 10/08/2022
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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 | 6203 PAYTON
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City | IRVINE
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State | CA
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Zip | 92620-3486
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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 |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 109426
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 132715
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License Number State | CA
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