Provider Demographics
NPI:1730305590
Name:MESHKOFF, JANICE EVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:EVAN
Last Name:MESHKOFF
Suffix:
Gender:F
Credentials:PHD
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 353
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-0353
Mailing Address - Country:US
Mailing Address - Phone:805-547-1585
Mailing Address - Fax:805-547-1585
Practice Address - Street 1:894 MEINECKE AVE
Practice Address - Street 2:#D
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1722
Practice Address - Country:US
Practice Address - Phone:805-547-1585
Practice Address - Fax:805-547-1585
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC14137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist