Provider Demographics
NPI:1992220271
Name:JUNG, MOLLIE (PSYD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:JUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1720
Mailing Address - Country:US
Mailing Address - Phone:626-225-2510
Mailing Address - Fax:
Practice Address - Street 1:181 N OAK KNOLL AVE STE 1
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4171
Practice Address - Country:US
Practice Address - Phone:626-225-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist