Provider Demographics
NPI:1336525088
Name:BOYLE, JENNIFER WONG (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WONG
Last Name:BOYLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 S SEPULVEDA BLVD APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4219
Mailing Address - Country:US
Mailing Address - Phone:415-939-1832
Mailing Address - Fax:
Practice Address - Street 1:10801 NATIONAL BLVD STE 251
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4141
Practice Address - Country:US
Practice Address - Phone:310-737-8562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist