Provider Demographics
NPI:1881820173
Name:JENNINGS, NORA M (MFT)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W FLETCHER AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2514
Mailing Address - Country:US
Mailing Address - Phone:714-488-4818
Mailing Address - Fax:714-637-7455
Practice Address - Street 1:228 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4320
Practice Address - Country:US
Practice Address - Phone:714-488-4818
Practice Address - Fax:714-637-7455
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist