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General NPI Number Information
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NPI Number | 1366644593
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Entity Type | Individual
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Provider Name | JEAN JORDAN WADE KUNST M.A., M.S., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 936 G STREET PARKSIDE FIRST UNITED METHODIST CHURCH
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City | WILLIAMS
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State | CA
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Zip | 95987
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Country | US
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Telephone | 530-902-4899
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Fax |
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Provider Business Mailing Address
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Address Line | 30998 COUNTY ROAD 29A
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City | WINTERS
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State | CA
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Zip | 95694-9021
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Country | US
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Telephone | 530-795-0617
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Fax |
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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 | 20569
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License Number State | CA
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