Provider Demographics
NPI:1275278483
Name:JAUREGUI, MARILYNN (BA)
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:JAUREGUI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 E 2ND ST APT 7
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5288
Mailing Address - Country:US
Mailing Address - Phone:714-856-0254
Mailing Address - Fax:
Practice Address - Street 1:3325 E 2ND ST APT 7
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5288
Practice Address - Country:US
Practice Address - Phone:714-856-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No171400000XOther Service ProvidersHealth & Wellness Coach
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist