Provider Demographics
NPI:1578328258
Name:HANNAH, JENIFER LEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:LEE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 LA RODA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-2111
Mailing Address - Country:US
Mailing Address - Phone:213-820-8356
Mailing Address - Fax:
Practice Address - Street 1:4930 LA RODA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2111
Practice Address - Country:US
Practice Address - Phone:213-820-8356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist