Provider Demographics
NPI:1891865143
Name:JARVIS, CATHLEEN ELEANOR (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ELEANOR
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 E UNIVERSITY DR
Mailing Address - Street 2:6B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-6930
Mailing Address - Country:US
Mailing Address - Phone:480-654-9870
Mailing Address - Fax:480-654-9860
Practice Address - Street 1:3660 E UNIVERSITY DR
Practice Address - Street 2:6B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6930
Practice Address - Country:US
Practice Address - Phone:480-654-9870
Practice Address - Fax:480-654-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW2276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health