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General NPI Number Information
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NPI Number | 1376005595
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Entity Type | Organization
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Legal Business Name | JEREMY HARVEY MARRIAGE AND FAMILY THERAPIST PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 260 NEWPORT CENTER DR STE 101
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7520
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Country | US
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Telephone | 949-945-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 51 VIA AMANTI
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City | NEWPORT COAST
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State | CA
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Zip | 92657-1124
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Country | US
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Telephone | 949-945-4364
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HARVEY JEREMY
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Credential |
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Telephone | 949-945-4364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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