Basic Information
| Provider Information | |||||||||
| NPI: | 1932175312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHEN | ||||||||
| FirstName: | JANETTA | ||||||||
| MiddleName: | SUE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4550 KEARNY VILLA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791123 | ||||||||
| FaxNumber: | 6195164757 | ||||||||
| Practice Location | |||||||||
| Address1: | 4550 KEARNY VILLA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791123 | ||||||||
| FaxNumber: | 6195164757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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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 | 106H00000X | LMFT35548 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.