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General NPI Number Information
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NPI Number | 1073828273
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Entity Type | Organization
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Legal Business Name | RESTORING FAMILY HARMONY
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 874 57TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3327
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Country | US
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Telephone | 916-739-1926
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Fax | 916-739-1591
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Provider Business Mailing Address
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Address Line | 874 57TH ST
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City | SACRAMENTO
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State | CA
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Zip | 95819-3327
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Country | US
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Telephone | 916-739-1926
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Fax | 916-739-1591
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JILL JEFFERS CLARK
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Credential | PHD.
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Telephone | 916-739-1926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 20715
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PSY 20715
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 24412
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 36061
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 20715
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License Number State | CA
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