Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | PT35097 | CA |
Y | 1041C0700X | Clinical Social Worker | 83626 | CA |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013215029 |
---|---|
Provider Name | Brieanne Marie Jennings |
First Address | South Pasadena, CA 91030-4729 |
Second Address | Los Angeles, CA 90020-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2011 |
Last Update Date | 09/04/2019 |