Basic Information
| Provider Information | |||||||||
| NPI: | 1669673570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRISCOE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | GALINDO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GALINDO | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | BERNARDO | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1203 WEEPINGGATE LANE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106765277 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3490 THE ALAMEDA | ||||||||
| Address2: | |||||||||
| City: | SANTA CLARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950504333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082430222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 112522 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.