Provider Demographics
NPI:1710597968
Name:LAM, JENNIFER T
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:LAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17284 NEWHOPE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-8201
Mailing Address - Country:US
Mailing Address - Phone:833-922-2669
Mailing Address - Fax:714-592-4401
Practice Address - Street 1:17284 NEWHOPE ST STE 212
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-8201
Practice Address - Country:US
Practice Address - Phone:833-922-2669
Practice Address - Fax:714-592-4401
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician