Healthcare Provider Details

I. General information

NPI: 1821278797
Provider Name (Legal Business Name): MECHELLE DENISE JUNGSTEN MA, MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 EL CAMINO AVE 5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

IV. Provider business mailing address

5030 EL CAMINO AVE
CARMICHAEL CA
95608-4650
US

V. Phone/Fax

Practice location:
  • Phone: 916-609-4956
  • Fax: 916-609-5160
Mailing address:
  • Phone: 916-609-4956
  • Fax: 916-609-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 54805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: