Provider Demographics
NPI:1982898045
Name:JELLA, STEVEN H (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:H
Last Name:JELLA
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5070 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2820
Mailing Address - Country:US
Mailing Address - Phone:619-920-8786
Mailing Address - Fax:
Practice Address - Street 1:5070 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2820
Practice Address - Country:US
Practice Address - Phone:619-920-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44808106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist