Provider Demographics
NPI:1891442919
Name:DAILEY, JEREMY TAIT (LMFT, PHD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:TAIT
Last Name:DAILEY
Suffix:
Gender:M
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23441 S POINTE DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1550
Mailing Address - Country:US
Mailing Address - Phone:949-842-0202
Mailing Address - Fax:
Practice Address - Street 1:23441 S POINTE DR STE 180
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1550
Practice Address - Country:US
Practice Address - Phone:949-842-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist