Provider Demographics
NPI:1790481901
Name:JH THERAPEUTIC
Entity Type:Organization
Organization Name:JH THERAPEUTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JARON
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:I
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-395-3657
Mailing Address - Street 1:575 OTAY LAKES RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1022
Mailing Address - Country:US
Mailing Address - Phone:619-395-3657
Mailing Address - Fax:
Practice Address - Street 1:8619 INNSDALE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7431
Practice Address - Country:US
Practice Address - Phone:619-395-3657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15288242070OtherMENTAL HEALTH