MEDICARE: JENNIFER ELAINE SEIDEL 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
1	106H00000X	Marriage & Family Therapist	MFC 44129	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MFC 44129	OTHER	CA	BBS LICENSE #

General Provider Information

NPI Number	:	1518098227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELAINE SEIDEL LMFT

Provider Business Mailing Address
First Line	:	3433 W SHAW AVE STE 107
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3229
Country	:	US
Telephone Number	:	559-558-4051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2934 N FRESNO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1123
Country	:	US
Telephone Number	:	559-688-2043
Fax Number	:	559-688-1304

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	09/13/2022

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