Healthcare Provider Details

I. General information

NPI: 1811099336
Provider Name (Legal Business Name): JEANNE M ROY M.A., M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W 4TH ST STE 200
CLAREMONT CA
91711-4707
US

IV. Provider business mailing address

230 GARFIELD AVE
POMONA CA
91767-3912
US

V. Phone/Fax

Practice location:
  • Phone: 909-896-9128
  • Fax:
Mailing address:
  • Phone: 909-896-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number29246
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: