Provider Demographics
NPI:1942615125
Name:JONGEWARD, DANIEL ROY
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROY
Last Name:JONGEWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:R
Other - Last Name:JONGEWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFC
Mailing Address - Street 1:570 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2424
Mailing Address - Country:US
Mailing Address - Phone:949-922-2353
Mailing Address - Fax:760-344-6550
Practice Address - Street 1:570 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2424
Practice Address - Country:US
Practice Address - Phone:949-922-2353
Practice Address - Fax:760-344-6550
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist