Provider Demographics
NPI:1205971520
Name:PATEL, JYOTSNABEN (MFT LICENSED)
Entity type:Individual
Prefix:MS
First Name:JYOTSNABEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MFT LICENSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CIVIC PLAZA DR FL 4
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2243
Mailing Address - Country:US
Mailing Address - Phone:213-944-1322
Mailing Address - Fax:
Practice Address - Street 1:1 CIVIC PLAZA DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2243
Practice Address - Country:US
Practice Address - Phone:213-944-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist