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NPI Code Detail

MEDICARE: MRS. JENNIFER HOLM CONWAY LMFT 90715

MEDICARE:  MRS. JENNIFER HOLM CONWAY  LMFT 90715
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2106H00000XMarriage & Family TherapistIMF 62030CA
3106H00000XMarriage & Family Therapist90715CA

General Provider Information

NPI Number : 1679748156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER HOLM CONWAY LMFT 90715
Provider Business Mailing Address
First Line : 5401 BUSINESS PARK S
Second Line : SUITE 208
City : BAKERSFIELD
State : CA
Zip : 93309-0721
Country : US
Telephone Number : 661-327-5100
Fax Number :
Provider Business Practice Location Address
First Line : 5401 BUSINESS PARK S
Second Line : SUITE 208
City : BAKERSFIELD
State : CA
Zip : 93309-0721
Country : US
Telephone Number : 661-327-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 12/10/2015

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