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General NPI Number Information
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NPI Number | 1619581733
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Entity Type | Individual
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Provider Name | JEFFREY ADRIANCE
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Gender | Male
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 4199 CAMPUS DR STE 550
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City | IRVINE
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State | CA
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Zip | 92612-4694
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Country | US
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Telephone | 940-422-4488
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1992
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City | LAKE ARROWHEAD
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State | CA
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Zip | 92352-1992
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Country | US
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Telephone | 949-678-9048
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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 | 97262
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License Number State | CA
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