Healthcare Provider Details

I. General information

NPI: 1649124686
Provider Name (Legal Business Name): JKM THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 E COLORADO BLVD # 5723
PASADENA CA
91107-3847
US

IV. Provider business mailing address

3016 E COLORADO BLVD # 5723
PASADENA CA
91107-3847
US

V. Phone/Fax

Practice location:
  • Phone: 603-770-2360
  • Fax:
Mailing address:
  • Phone: 603-770-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNYMAE MARTIN
Title or Position: OWNER
Credential: LPCC
Phone: 603-770-2360