Basic Information
| Provider Information | |||||||||
| NPI: | 1659586634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAKOWSKI | ||||||||
| FirstName: | KARLEEN | ||||||||
| MiddleName: | KEHAU HARMONY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WATSON | ||||||||
| OtherFirstName: | KARLEEN | ||||||||
| OtherMiddleName: | KEHAU HARMONY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1965 LIVE OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959918850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227478 | ||||||||
| FaxNumber: | 5308227484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1965 LIVE OAK BLVD | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959918850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308227478 | ||||||||
| FaxNumber: | 5308227484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0125871 | NM | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 106H00000X | IMF-58871 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | MFC 53472 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.