Provider Demographics
NPI:1093996126
Name:CHANG, JENNY (MFT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 VALLEY HI DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-7076
Mailing Address - Country:US
Mailing Address - Phone:916-681-6300
Mailing Address - Fax:916-681-6354
Practice Address - Street 1:6615 VALLEY HI DR
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-7076
Practice Address - Country:US
Practice Address - Phone:916-681-6300
Practice Address - Fax:916-681-6354
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50934106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist