Provider Demographics
NPI:1902952807
Name:JENNINGS, PATRICIA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:720 WILSHIRE BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1737
Mailing Address - Country:US
Mailing Address - Phone:424-229-5028
Mailing Address - Fax:424-229-5528
Practice Address - Street 1:720 WILSHIRE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1737
Practice Address - Country:US
Practice Address - Phone:424-229-5028
Practice Address - Fax:424-229-5528
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11663234OtherCAQH
CA11663234OtherCAQH