Provider Demographics
NPI:1861509770
Name:BOVE, JODY HELENE (MFC)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:HELENE
Last Name:BOVE
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3684
Mailing Address - Country:US
Mailing Address - Phone:925-285-7458
Mailing Address - Fax:925-299-1924
Practice Address - Street 1:3704 MT DIABLO BLVD
Practice Address - Street 2:SUITE 316
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3684
Practice Address - Country:US
Practice Address - Phone:925-285-7458
Practice Address - Fax:925-299-1924
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist