Provider Demographics
NPI:1023335569
Name:DANIEL-FARRELL, JAMIE RUTH (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:RUTH
Last Name:DANIEL-FARRELL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:RUTH
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:860 HAMPSHIRE RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:WEST LAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-444-4968
Mailing Address - Fax:805-262-6280
Practice Address - Street 1:860 HAMPSHIRE RD
Practice Address - Street 2:SUITE L
Practice Address - City:WEST LAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361
Practice Address - Country:US
Practice Address - Phone:805-444-4968
Practice Address - Fax:805-262-6280
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherOTHER