MEDICARE: DR. JENNIFER FEE PSYCHOLOGY SERVICES, INC

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
2	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932101326	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1780250282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JENNIFER FEE PSYCHOLOGY SERVICES, INC

Provider Business Mailing Address
First Line	:	1601 DOVE ST STE 105
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2410
Country	:	US
Telephone Number	:	562-760-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 DOVE ST STE 105
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2410
Country	:	US
Telephone Number	:	562-760-2743
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENNIFER L FEE
Credential	:	PSYD
Telephone Number	:	562-760-2743

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	06/03/2021

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