Provider Demographics
NPI:1871796409
Name:FRIEND, JENNY (MFT)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:FRIEND
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 1:1850 E 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8625
Mailing Address - Country:US
Mailing Address - Phone:714-543-3900
Mailing Address - Fax:714-543-3969
Practice Address - Street 1:1850 E 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8625
Practice Address - Country:US
Practice Address - Phone:714-543-3900
Practice Address - Fax:714-543-3969
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist