Provider Demographics
NPI:1346766581
Name:J.E.M. CLINICAL COUNSELING, LLC
Entity Type:Organization
Organization Name:J.E.M. CLINICAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPCC
Authorized Official - Phone:760-496-9600
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92049-0664
Mailing Address - Country:US
Mailing Address - Phone:760-496-9600
Mailing Address - Fax:858-408-6504
Practice Address - Street 1:815 MISSION AVE STE 208
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2841
Practice Address - Country:US
Practice Address - Phone:760-496-9600
Practice Address - Fax:858-408-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ284999Medicaid