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General NPI Number Information
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NPI Number | 1932809670
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Entity Type | Organization
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Legal Business Name | JEONGTHERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 432 S WILLAMAN DR
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City | LOS ANGELES
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State | CA
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Zip | 90048-6718
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Country | US
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Telephone | 213-761-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 3010 WILSHIRE BLVD # 354
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City | LOS ANGELES
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State | CA
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Zip | 90010-1103
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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 | OWNER
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Name | HONG JEONG
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Credential |
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Telephone | 253-651-8072
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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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