Provider Demographics
NPI:1003248014
Name:JEANDRON, GARY (MFT)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:JEANDRON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80225 GREEN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0847
Mailing Address - Country:US
Mailing Address - Phone:760-218-4000
Mailing Address - Fax:
Practice Address - Street 1:43585 MONTEREY AVE
Practice Address - Street 2:STE 4
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9342
Practice Address - Country:US
Practice Address - Phone:760-345-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist