Healthcare Provider Details

I. General information

NPI: 1588289052
Provider Name (Legal Business Name): JAHMAHL SLATER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA ST
CARPINTERIA CA
93013-1501
US

IV. Provider business mailing address

160 MCKNIGHT RD
NEWBURY PARK CA
91320-4722
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0299
  • Fax:
Mailing address:
  • Phone: 747-732-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: