Provider Demographics
NPI:1588012090
Name:SUARD, JAMIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:SUARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 PACIFIC COAST HWY STE 325
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2236
Mailing Address - Country:US
Mailing Address - Phone:310-503-7702
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 325
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2225
Practice Address - Country:US
Practice Address - Phone:310-503-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist