Provider Demographics
NPI:1336802743
Name:KWON, JANE (LMFT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KWON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12629 RIVERSIDE DR APT 336
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3490
Mailing Address - Country:US
Mailing Address - Phone:510-364-8908
Mailing Address - Fax:
Practice Address - Street 1:12629 RIVERSIDE DR APT 336
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3490
Practice Address - Country:US
Practice Address - Phone:510-364-8908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144792106H00000X
CA105290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist