Provider Demographics
NPI:1427294156
Name:PAUL, JENNIFER LEE
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LEE
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6831 PRESIDIO DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3065
Mailing Address - Country:US
Mailing Address - Phone:714-371-5462
Mailing Address - Fax:714-969-4496
Practice Address - Street 1:2183 FAIRVIEW RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5663
Practice Address - Country:US
Practice Address - Phone:949-515-5440
Practice Address - Fax:714-515-5444
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health