Basic Information
| Provider Information | |||||||||
| NPI: | 1639352503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIZARRAGA | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 877 W EL REPETTO DR | ||||||||
| Address2: | APT A20 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917545217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267445230 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 E FOOTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237445230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2007 | ||||||||
| LastUpdateDate: | 03/21/2016 | ||||||||
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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 | 54192 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 54192 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 919503 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.