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General NPI Number Information
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NPI Number | 1487986071
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Entity Type | Organization
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Legal Business Name | JURATE PSYCHOTHERAPY AND CONSULTING INC.
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 9666 BUSINESSPARK AVE STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1646
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Country | US
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Telephone | 858-566-2771
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Fax | 858-536-8201
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Provider Business Mailing Address
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Address Line | 9666 BUSINESSPARK AVE STE 101
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City | SAN DIEGO
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State | CA
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Zip | 92131-1646
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Country | US
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Telephone | 858-566-2771
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Fax | 858-536-8204
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA ANNE PETRONIS
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Credential | MA, LMFT PHD
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Telephone | 619-787-2771
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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 | MFC 41727
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License Number State | CA
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