Provider Demographics
NPI:1831367960
Name:JAMES, JENNIFER JEAN (MFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:JAMES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3953 CENTRE ST
Mailing Address - Street 2:2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3472
Mailing Address - Country:US
Mailing Address - Phone:619-894-0436
Mailing Address - Fax:
Practice Address - Street 1:4417 30TH ST
Practice Address - Street 2:114
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4284
Practice Address - Country:US
Practice Address - Phone:619-894-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist