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General NPI Number Information
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NPI Number | 1336203355
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Entity Type | Organization
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Legal Business Name | JEWISH FAMILY AND CHILDREN'S SERVICES
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1360 N DUTTON AVE SUITE C
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City | SANTA ROSA
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State | CA
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Zip | 95401-4687
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Country | US
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Telephone | 707-571-8131
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Fax | 707-571-8195
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Provider Business Mailing Address
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Address Line | 1360 N DUTTON AVE SUITE C
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City | SANTA ROSA
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State | CA
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Zip | 95401-4687
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Country | US
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Telephone | 707-571-8131
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Fax | 707-571-8195
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | LYNNE W. JOACHIM
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Credential | M.F.T.
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Telephone | 707-571-8131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC24484
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License Number State | CA
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