MEDICARE: MS. JAMAICA ALYISA CHENOWETH MS, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	135800	CA

General Provider Information

NPI Number	:	1245785419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMAICA ALYISA CHENOWETH MS, LMFT

Provider Business Mailing Address
First Line	:	370 IMPERIAL WAY
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2567
Country	:	US
Telephone Number	:	530-615-8714
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 IMPERIAL WAY
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2567
Country	:	US
Telephone Number	:	530-615-8714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	09/17/2024

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