Provider Demographics
NPI:1801039094
Name:JEFF PALITZ MFT INC
Entity type:Organization
Organization Name:JEFF PALITZ MFT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PALITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-271-8886
Mailing Address - Street 1:2400 FENTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3596
Mailing Address - Country:US
Mailing Address - Phone:619-271-8886
Mailing Address - Fax:619-414-1277
Practice Address - Street 1:2400 FENTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3596
Practice Address - Country:US
Practice Address - Phone:619-271-8886
Practice Address - Fax:619-414-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41250251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health