Provider Demographics
NPI:1215288717
Name:SMITH, JENNIFER LYN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:TRESTIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2043 WESTCLIFF DR, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-922-8661
Mailing Address - Fax:949-955-0163
Practice Address - Street 1:2043 WESTCLIFF DR, SUITE 201
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-922-8661
Practice Address - Fax:949-955-0163
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist