Basic Information
| Provider Information | |||||||||
| NPI: | 1255459533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHIBA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | RIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2658 GRIFFITH PARK BLVD # 151 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900392520 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7600 GRAVES AVE | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917703414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262806510 | ||||||||
| FaxNumber: | 6262881026 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 49412 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 49812 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.