Healthcare Provider Details

I. General information

NPI: 1285578740
Provider Name (Legal Business Name): PEER SUPPORT NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12191 CUYAMACA COLLEGE DR E UNIT 215
EL CAJON CA
92019-4333
US

IV. Provider business mailing address

308 THRUSH ST
SAN DIEGO CA
92114-4125
US

V. Phone/Fax

Practice location:
  • Phone: 619-988-6789
  • Fax:
Mailing address:
  • Phone: 619-988-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AMY JEFFERS
Title or Position: COO
Credential: RCFE ADMINISTRATOR
Phone: 619-988-6789