Provider Demographics
NPI:1982774139
Name:LANSDON, JENNIFER ROSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ROSE
Last Name:LANSDON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1323 W GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4622
Mailing Address - Country:US
Mailing Address - Phone:714-307-6277
Mailing Address - Fax:
Practice Address - Street 1:3540 HOWARD WAY STE 150
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1417
Practice Address - Country:US
Practice Address - Phone:949-646-9227
Practice Address - Fax:949-646-9191
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health