Healthcare Provider Details

I. General information

NPI: 1104941202
Provider Name (Legal Business Name): J'LENE KURTZ LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

IV. Provider business mailing address

1965 LIVE OAK BLVD
YUBA CITY CA
95991-8828
US

V. Phone/Fax

Practice location:
  • Phone: 530-822-7200
  • Fax: 530-674-7856
Mailing address:
  • Phone: 530-822-7200
  • Fax: 530-822-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: