Healthcare Provider Details

I. General information

NPI: 1639543960
Provider Name (Legal Business Name): JAYNE MARSH LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 S BASCOM AVE SUITE 216
SAN JOSE CA
95124-2674
US

IV. Provider business mailing address

PO BOX 2312
MORGAN HILL CA
95038-2312
US

V. Phone/Fax

Practice location:
  • Phone: 408-236-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number84356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number84356
License Number StateCA

VIII. Authorized Official

Name: JAYNE MARSH
Title or Position: LIC. MARRIAGE & FAMILY THERAPIST
Credential: L.M.F.T.
Phone: 408-236-2111