Provider Demographics
NPI:1205123189
Name:NORHEIM, JENNIFER MICHELLE (MFCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:NORHEIM
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFCC
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:#300B
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-400-5331
Mailing Address - Fax:
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:#300B
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-400-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30225106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist