Healthcare Provider Details

I. General information

NPI: 1578694766
Provider Name (Legal Business Name): JANIE SPURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 K ST
MODESTO CA
95354-1018
US

IV. Provider business mailing address

2925 NIAGRA ST SUITE 3
TURLOCK CA
95382-1056
US

V. Phone/Fax

Practice location:
  • Phone: 209-523-4573
  • Fax:
Mailing address:
  • Phone: 209-669-6771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number59161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: