Provider Demographics
NPI:1326176306
Name:YIP, JEN (MA)
Entity Type:Individual
Prefix:MS
First Name:JEN
Middle Name:
Last Name:YIP
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:YIP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1255 LINCOLN ST. #21
Mailing Address - Street 2:APT/SUITE 21
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6038
Mailing Address - Country:US
Mailing Address - Phone:408-703-4241
Mailing Address - Fax:408-703-4241
Practice Address - Street 1:1550 WINCHESTER BLVD.,
Practice Address - Street 2:SUITE 214
Practice Address - City:CAMPTBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2631
Practice Address - Country:US
Practice Address - Phone:408-703-4241
Practice Address - Fax:408-703-4241
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC47767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health