Provider Demographics
NPI:1780989764
Name:MCMAINS, JENNIFER LYNNE (MFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:MCMAINS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10675 ESMERALDAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2007
Mailing Address - Country:US
Mailing Address - Phone:619-727-3673
Mailing Address - Fax:
Practice Address - Street 1:9820 WILLOW CREEK RD
Practice Address - Street 2:SUITE 243
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1112
Practice Address - Country:US
Practice Address - Phone:619-727-3673
Practice Address - Fax:858-484-1848
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49471106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist