Provider Demographics
NPI:1588173025
Name:HYATT, JENNIFER
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:HYATT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27393 YNEZ RD STE 151
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4605
Mailing Address - Country:US
Mailing Address - Phone:951-595-7244
Mailing Address - Fax:951-240-3673
Practice Address - Street 1:27393 YNEZ RD STE 151
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4605
Practice Address - Country:US
Practice Address - Phone:951-595-7244
Practice Address - Fax:951-240-3673
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99355106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist