Provider Demographics
NPI:1124278486
Name:MIRAMONTES, JENNIFER G (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:MIRAMONTES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:GRACE
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:31356 VIA COLINAS STE 114
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6864
Mailing Address - Country:US
Mailing Address - Phone:310-213-0027
Mailing Address - Fax:877-820-1915
Practice Address - Street 1:31356 VIA COLINAS STE 114
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-6864
Practice Address - Country:US
Practice Address - Phone:310-213-0027
Practice Address - Fax:877-820-1915
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist