Healthcare Provider Details

I. General information

NPI: 1376005595
Provider Name (Legal Business Name): JEREMY HARVEY MARRIAGE AND FAMILY THERAPIST PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NEWPORT CENTER DR STE 101
NEWPORT BEACH CA
92660-7520
US

IV. Provider business mailing address

51 VIA AMANTI
NEWPORT COAST CA
92657-1124
US

V. Phone/Fax

Practice location:
  • Phone: 949-945-4364
  • Fax:
Mailing address:
  • Phone: 949-945-4364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HARVEY JEREMY
Title or Position: PRESIDENT
Credential:
Phone: 949-945-4364