Provider Demographics
NPI:1154912384
Name:CHA, JENNIFER (AMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CHA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:MIN
Other - Middle Name:KYUNG
Other - Last Name:CHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16250 VENTURA BLVD STE 465
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4620
Mailing Address - Country:US
Mailing Address - Phone:818-906-0406
Mailing Address - Fax:818-981-0649
Practice Address - Street 1:16250 VENTURA BLVD STE 465
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4620
Practice Address - Country:US
Practice Address - Phone:818-906-0406
Practice Address - Fax:818-981-0649
Is Sole Proprietor?:No
Enumeration Date:2021-01-30
Last Update Date:2021-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist