MEDICARE: JENNIFER FARD

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	104661	CA

General Provider Information

NPI Number	:	1255633517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER FARD

Provider Business Mailing Address
First Line	:	1077 PACIFIC COAST HWY # 191
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6214
Country	:	US
Telephone Number	:	949-229-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	23041 AVENIDA DE LA CARLOTA
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1511
Country	:	US
Telephone Number	:	949-229-1463
Fax Number	:

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

Provider Enumeration Date	:	11/18/2010
Last Update Date	:	01/05/2022

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