Provider Demographics
NPI:1790143741
Name:JANE PETTIS WINSLOW
Entity Type:Organization
Organization Name:JANE PETTIS WINSLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:PETTIS
Authorized Official - Last Name:WINSLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-779-1280
Mailing Address - Street 1:1751 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7005
Mailing Address - Country:US
Mailing Address - Phone:310-779-1280
Mailing Address - Fax:
Practice Address - Street 1:1751 1ST ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-7005
Practice Address - Country:US
Practice Address - Phone:310-779-1280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50716251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management