Provider Demographics
NPI:1154343085
Name:TREADWAY-MOLLE, JENNIFER (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TREADWAY-MOLLE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N KRAEMER BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5002
Mailing Address - Country:US
Mailing Address - Phone:714-402-2719
Mailing Address - Fax:
Practice Address - Street 1:151 N KRAEMER BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5002
Practice Address - Country:US
Practice Address - Phone:714-402-2719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist