Provider Demographics
NPI:1598137358
Name:JENNIFER ADDERLY, LMFT
Entity Type:Organization
Organization Name:JENNIFER ADDERLY, LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADDERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-445-5678
Mailing Address - Street 1:5351 W AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1033
Mailing Address - Country:US
Mailing Address - Phone:323-445-5678
Mailing Address - Fax:
Practice Address - Street 1:8285 W SUNSET BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-2400
Practice Address - Country:US
Practice Address - Phone:323-445-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT88485261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health