Provider Demographics
NPI:1437834777
Name:MAYER, JILLIAN LINDSEY (AMFT)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:LINDSEY
Last Name:MAYER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4955 NARRAGANSETT AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-6116
Mailing Address - Country:US
Mailing Address - Phone:184-796-2493
Mailing Address - Fax:
Practice Address - Street 1:4955 NARRAGANSETT AVE APT 10
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-6116
Practice Address - Country:US
Practice Address - Phone:184-796-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health