Provider Demographics
NPI:1699024869
Name:JUNG, ANNIE KNAZS (MA, LPCC,)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:KNAZS
Last Name:JUNG
Suffix:
Gender:F
Credentials:MA, LPCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 PESCARA BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-2991
Mailing Address - Country:US
Mailing Address - Phone:925-759-7200
Mailing Address - Fax:
Practice Address - Street 1:613 1ST ST
Practice Address - Street 2:SUITE 217
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1397
Practice Address - Country:US
Practice Address - Phone:925-392-5967
Practice Address - Fax:925-626-4237
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional