Healthcare Provider Details

I. General information

NPI: 1932588076
Provider Name (Legal Business Name): JASON S TEMPLE MA, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19330 JESSE LN # 280
RIVERSIDE CA
92508-5091
US

IV. Provider business mailing address

19322 JESSE LN STE 200
RIVERSIDE CA
92508-5072
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-4040
  • Fax: 951-398-3144
Mailing address:
  • Phone: 951-387-4040
  • Fax: 951-398-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: