Provider Demographics
NPI:1700513876
Name:JEON, MINKYO (LMFT)
Entity type:Individual
Prefix:
First Name:MINKYO
Middle Name:
Last Name:JEON
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 1:1968 W ADAMS BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-3515
Mailing Address - Country:US
Mailing Address - Phone:323-731-3534
Mailing Address - Fax:323-731-5618
Practice Address - Street 1:1968 W ADAMS BLVD # 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-3515
Practice Address - Country:US
Practice Address - Phone:323-731-3534
Practice Address - Fax:323-731-5618
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA155020106H00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist