Provider Demographics
NPI:1215107024
Name:POURVASEI, JENNIFER MCNALLY (MFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MCNALLY
Last Name:POURVASEI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 DOVE ST
Mailing Address - Street 2:STE 230
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2433
Mailing Address - Country:US
Mailing Address - Phone:949-292-5576
Mailing Address - Fax:
Practice Address - Street 1:1221 E DYER RD STE 220
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5632
Practice Address - Country:US
Practice Address - Phone:714-323-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist