Provider Demographics
NPI:1376005595
Name:JEREMY HARVEY MFT PC
Entity Type:Organization
Organization Name:JEREMY HARVEY MFT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEREMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-945-4364
Mailing Address - Street 1:51 VIA AMANTI
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1124
Mailing Address - Country:US
Mailing Address - Phone:949-945-4364
Mailing Address - Fax:
Practice Address - Street 1:260 NEWPORT CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7520
Practice Address - Country:US
Practice Address - Phone:949-945-4364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health