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NPI Code Detail

MEDICARE: ERIN FENNELL LMFT

MEDICARE: ERIN FENNELL LMFT
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
1106H00000XMarriage & Family Therapist102874CA
2106H00000XMarriage & Family TherapistBBH-LMFT-LIC-87690MT
3106H00000XMarriage & Family TherapistMBTMFT-10270ID

General Provider Information

NPI Number : 1083091094
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN FENNELL LMFT
Provider Business Mailing Address
First Line : 30025 ALICIA PKWY # 20-2200
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-2090
Country : US
Telephone Number : 949-478-5288
Fax Number :
Provider Business Practice Location Address
First Line : 28202 CABOT RD STE 300
Second Line :
City : LAGUNA NIGUEL
State : CA
Zip : 92677-1249
Country : US
Telephone Number : 949-478-5288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2015
Last Update Date : 03/03/2026

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