Provider Demographics
NPI:1942481312
Name:DOVERSPIKE, JEAN ANNE (MFT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANNE
Last Name:DOVERSPIKE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 PARK AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2920
Mailing Address - Country:US
Mailing Address - Phone:831-454-1798
Mailing Address - Fax:
Practice Address - Street 1:3121 PARK AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2920
Practice Address - Country:US
Practice Address - Phone:831-454-1798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist