Provider Demographics
NPI:1235681677
Name:NGUYEN, JENNIFER TUYET (MA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TUYET
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:12361 LEWIS ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4683
Mailing Address - Country:US
Mailing Address - Phone:714-390-2662
Mailing Address - Fax:
Practice Address - Street 1:12361 LEWIS ST STE 101
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4683
Practice Address - Country:US
Practice Address - Phone:714-390-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-30040103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty