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General NPI Number Information
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NPI Number | 1891043865
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Entity Type | Individual
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Provider Name | JENNA I METELLUS PSYD
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Gender | Female
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Dates
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Enumeration Date | 08/24/2012
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 6320 CANOGA AVE
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-2526
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Country | US
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Telephone | 818-227-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 57064
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City | SHERMAN OAKS
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State | CA
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Zip | 91413-2064
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Country | US
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Telephone |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 30486
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License Number State | CA
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