Healthcare Provider Details

I. General information

NPI: 1609523554
Provider Name (Legal Business Name): JEAN LAMPERT MARRIAGE & FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 RADCLIFF ST
VENTURA CA
93003-2134
US

IV. Provider business mailing address

PO BOX 6538
VENTURA CA
93006-6538
US

V. Phone/Fax

Practice location:
  • Phone: 805-223-5219
  • Fax:
Mailing address:
  • Phone: 805-223-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEAN LAMPERT
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 805-223-5219