Provider Demographics
NPI:1619073608
Name:JAHAN, CAROLYN KAY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:KAY
Last Name:JAHAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:KAY
Other - Last Name:JAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2743 ARBOLADO
Mailing Address - Street 2:
Mailing Address - City:SAM CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-275-3445
Mailing Address - Fax:949-492-4081
Practice Address - Street 1:161 AVE CABRILLO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:949-275-3445
Practice Address - Fax:949-492-4081
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34502106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist