Provider Demographics
NPI:1093951741
Name:POWERS, JEAN BETH WOLFE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:BETH WOLFE
Last Name:POWERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:BETH
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2312 STORMCROFT CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2054
Mailing Address - Country:US
Mailing Address - Phone:805-204-8192
Mailing Address - Fax:
Practice Address - Street 1:2312 STORMCROFT CT
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2054
Practice Address - Country:US
Practice Address - Phone:805-204-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001090106H00000X
CAMFC25278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist