Basic Information
| Provider Information | |||||||||
| NPI: | 1508885179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8211 SAN ANGELO DR | ||||||||
| Address2: | G14 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926479217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143317356 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1615 FRENCH ST | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248140 | ||||||||
| FaxNumber: | 7148248141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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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 | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.