Provider Demographics
NPI:1700634144
Name:GALBRAITH, JASON DEAN (R1558470424)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DEAN
Last Name:GALBRAITH
Suffix:
Gender:M
Credentials:R1558470424
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16542 SILKTREE ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2347
Mailing Address - Country:US
Mailing Address - Phone:714-715-9096
Mailing Address - Fax:
Practice Address - Street 1:16542 SILKTREE ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2347
Practice Address - Country:US
Practice Address - Phone:714-715-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1558470424101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)