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General NPI Number Information
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NPI Number | 1285935478
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Entity Type | Individual
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Provider Name | MICHAEL STEVEN JEREB M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 631 TENNESSE ST
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City | VALLEJO
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State | CA
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Zip | 94590
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Country | US
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Telephone | 707-421-3021
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Fax | 707-256-3102
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Provider Business Mailing Address
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Address Line | P.O. BOX 10043
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City | AMERICAN CANYON
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State | CA
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Zip | 94503
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Country | US
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Telephone | 707-421-3021
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Fax | 707-256-3102
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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 | MFT33781
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License Number State | CA
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