Healthcare Provider Details

I. General information

NPI: 1649191933
Provider Name (Legal Business Name): JENJIRA MICHELLE MILAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MISSION ST
SAN FRANCISCO CA
94103-2417
US

IV. Provider business mailing address

2114 ESSEX ST APT A
BERKELEY CA
94705-1878
US

V. Phone/Fax

Practice location:
  • Phone: 141-556-5766
  • Fax:
Mailing address:
  • Phone: 206-488-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21148
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: