Provider Demographics
NPI:1780796946
Name:JAY, JOHN BRUCE (MAMFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRUCE
Last Name:JAY
Suffix:
Gender:M
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE# 604
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3302
Mailing Address - Country:US
Mailing Address - Phone:562-508-3838
Mailing Address - Fax:562-597-5692
Practice Address - Street 1:5199 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE# 604
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3302
Practice Address - Country:US
Practice Address - Phone:562-508-3838
Practice Address - Fax:562-597-5692
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 16367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist