Provider Demographics
NPI:1427320605
Name:JENNIFER LUNDY FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:JENNIFER LUNDY FAMILY THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUNDY-AGUERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-733-6414
Mailing Address - Street 1:5480 BALTIMORE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2066
Mailing Address - Country:US
Mailing Address - Phone:619-733-6414
Mailing Address - Fax:619-303-3306
Practice Address - Street 1:5480 BALTIMORE DR STE 250
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2066
Practice Address - Country:US
Practice Address - Phone:619-733-6414
Practice Address - Fax:619-303-3306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21402103TC0700X
CA42025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty