Healthcare Provider Details

I. General information

NPI: 1255820221
Provider Name (Legal Business Name): JACQUELYN ASHLEY CORVAN HELMER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN CORVAN PHD

II. Dates (important events)

Enumeration Date: 05/05/2018
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 220-C
LA MESA CA
91942-6002
US

IV. Provider business mailing address

5360 JACKSON DR STE 220-C
LA MESA CA
91942-6002
US

V. Phone/Fax

Practice location:
  • Phone: 619-439-8479
  • Fax: 619-916-2457
Mailing address:
  • Phone: 619-439-8479
  • Fax: 619-916-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY28014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: