Provider Demographics
NPI:1447781745
Name:UN, JEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:UN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:UN
Other - Last Name:SOMPHONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5152 KATELLA AVE STE 205-A
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2817
Mailing Address - Country:US
Mailing Address - Phone:562-248-6682
Mailing Address - Fax:
Practice Address - Street 1:5152 KATELLA AVE STE 205-A
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2817
Practice Address - Country:US
Practice Address - Phone:562-248-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS199871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical