Provider Demographics
NPI:1538445325
Name:MUSSELMAN, JENNIFER DAWN (MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DAWN
Last Name:MUSSELMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:MUSSELMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:11911 SAN VICENTE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6619
Mailing Address - Country:US
Mailing Address - Phone:310-614-4660
Mailing Address - Fax:
Practice Address - Street 1:11911 SAN VICENTE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6619
Practice Address - Country:US
Practice Address - Phone:310-614-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA93511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health