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MS. JACKIE A PROVENCHER AMFT NPI 1497397939


NPI Information

NPI: 1497397939
Provider Name: MS. JACKIE A PROVENCHER, AMFT
Classification: Marriage & Family Therapist - 106H00000X
Entity Type: Individual
Address:
2211 E OCEAN BLVD
LONG BEACH, CA
ZIP 90803
Phone: (562) 434-4060
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MS. Jackie A Provencher, AMFT is a marriage family therapist in Long Beach, CA. The provider is a marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. MS. Jackie A Provencher, AMFT NPI is 1497397939. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2211 E OCEAN BLVD
LONG BEACH, CA
ZIP 90803-440
Phone: (562) 434-4060

The enumeration date for this NPI number is 10/16/2019 and was last updated on 10/16/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1106H00000XMarriage & Family Therapist79380CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
179380OTHERCALIFORNIAMARRIAGE AND FAMILY THERAPIST ASSOCIATE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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