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General NPI Number Information
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NPI Number | 1093833774
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Entity Type | Individual
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Provider Name | JAYNE DIANA MUSEITIF MSMFT
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 04/27/2025
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Provider Practice Location Address
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Address Line | 415 HOWARD ST APT 1802
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City | EVANSTON
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State | IL
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Zip | 60202-4057
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Country | US
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Telephone | 773-217-9729
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 SHERMAN AVE STE 155
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City | EVANSTON
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State | IL
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Zip | 60201-4421
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Country | US
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Telephone | 773-217-9729
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Fax | 999-999-9999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000753
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License Number State | IL
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