Provider Demographics
NPI:1770645426
Name:MALAN, JACK JR (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:
Last Name:MALAN
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 ATLAS PEAK RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-9316
Mailing Address - Country:US
Mailing Address - Phone:707-255-0444
Mailing Address - Fax:
Practice Address - Street 1:2945 ATLAS PEAK RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-9316
Practice Address - Country:US
Practice Address - Phone:707-255-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMP22330106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist