Provider Demographics
NPI:1346068129
Name:NGUYEN, JENNY T (PPS,)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PPS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 LARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2320
Mailing Address - Country:US
Mailing Address - Phone:714-894-7218
Mailing Address - Fax:714-898-6176
Practice Address - Street 1:6311 LARCHWOOD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2320
Practice Address - Country:US
Practice Address - Phone:714-894-7218
Practice Address - Fax:714-838-6176
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool