Provider Demographics
NPI:1720621360
Name:JAIN, CHRISTOPHER ROSS
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROSS
Last Name:JAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 MT DIABLO BLVD STE B201
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3959
Mailing Address - Country:US
Mailing Address - Phone:719-337-6981
Mailing Address - Fax:
Practice Address - Street 1:3468 MT DIABLO BLVD STE B201
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3959
Practice Address - Country:US
Practice Address - Phone:925-385-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-27
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist