Provider Demographics
NPI:1942494786
Name:CHANG, JENSS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENSS
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENSS
Other - Middle Name:CHANG
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8300 UTICA AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3852
Mailing Address - Country:US
Mailing Address - Phone:909-989-4055
Mailing Address - Fax:
Practice Address - Street 1:8300 UTICA AVE STE 245
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3852
Practice Address - Country:US
Practice Address - Phone:909-989-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
CAPSY25491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling