Basic Information
| Provider Information | |||||||||
| NPI: | 1982913281 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WAID | ||||||||
| FirstName: | JO | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 508 S 2ND AVENUE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917236261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269748123 | ||||||||
| FaxNumber: | 6269748198 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 S 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917233012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269748122 | ||||||||
| FaxNumber: | 6269748198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2010 | ||||||||
| LastUpdateDate: | 06/02/2017 | ||||||||
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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 | IMF99614 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMF 67079 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.