Provider Demographics
NPI:1720111362
Name:JAIME, MARIE ELENA
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ELENA
Last Name:JAIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ELENA
Other - Last Name:JAIME-PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 N COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2585
Mailing Address - Country:US
Mailing Address - Phone:530-406-4862
Mailing Address - Fax:530-668-1974
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2998
Practice Address - Country:US
Practice Address - Phone:530-406-4862
Practice Address - Fax:530-668-1974
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor