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General NPI Number Information
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NPI Number | 1699481903
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Entity Type | Organization
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Legal Business Name | JERRI MIDDLETON, LCSW
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 2717 SPICEWOOD LN
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City | RIVERSIDE
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State | CA
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Zip | 92504-4319
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Country | US
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Telephone | 951-223-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 5198 ARLINGTON AVE STE 260
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City | RIVERSIDE
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State | CA
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Zip | 92504-2603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | JERRI MIDDLETON
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Credential | LCSW
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Telephone | 951-223-8295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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