Provider Demographics
NPI:1336203355
Name:JEWISH FAMILY AND CHILDREN'S SERVICES
Entity Type:Organization
Organization Name:JEWISH FAMILY AND CHILDREN'S SERVICES
Other - Org Name:PARENTS PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOACHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:707-571-8131
Mailing Address - Street 1:1360 N DUTTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4687
Mailing Address - Country:US
Mailing Address - Phone:707-571-8131
Mailing Address - Fax:707-571-8195
Practice Address - Street 1:1360 N DUTTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4687
Practice Address - Country:US
Practice Address - Phone:707-571-8131
Practice Address - Fax:707-571-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24484251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 24484OtherLICENSE MFT