Provider Demographics
NPI:1710117411
Name:JEAN, CHRISTY (BA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92033-0632
Mailing Address - Country:US
Mailing Address - Phone:760-746-5747
Mailing Address - Fax:
Practice Address - Street 1:130 S FIG ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4401
Practice Address - Country:US
Practice Address - Phone:760-746-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABA HUMAN SERVICES1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool