MEDICARE: LAUREN MARIE FENSTERMAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	146412	CA
2	101YP2500X	Professional Counselor	16420	CA

General Provider Information

NPI Number	:	1023859584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN MARIE FENSTERMAKER

Provider Business Mailing Address
First Line	:	5150 VIA PRIMARIA
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4586
Country	:	US
Telephone Number	:	714-271-0685
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 S GRAND AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-4434
Country	:	US
Telephone Number	:	714-271-0685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	02/24/2026

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