Provider Demographics
NPI:1922152727
Name:VONSTETTEN, JEFFREY S (BS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:S
Last Name:VONSTETTEN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 OCEAN AVE APT D
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6174
Mailing Address - Country:US
Mailing Address - Phone:714-290-1703
Mailing Address - Fax:
Practice Address - Street 1:1900 E LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1647
Practice Address - Country:US
Practice Address - Phone:714-399-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health