Provider Demographics
NPI:1114593738
Name:DUDLEY, JEAN ELIZABETH (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ELIZABETH
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ELIZABETH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:6906 MIRAMAR RD STE C-164
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2666
Mailing Address - Country:US
Mailing Address - Phone:281-782-1359
Mailing Address - Fax:
Practice Address - Street 1:6906 MIRAMAR RD STE C-164
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2666
Practice Address - Country:US
Practice Address - Phone:281-782-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist