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General NPI Number Information
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NPI Number | 1790337848
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Entity Type | Organization
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Legal Business Name | SHEEPDOG FITNESS, LLC
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 34207 PACIFIC COAST HWY STE A
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City | DANA POINT
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State | CA
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Zip | 92629-2849
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Country | US
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Telephone | 949-291-1283
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Fax |
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Provider Business Mailing Address
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Address Line | 34207 PACIFIC COAST HWY STE A
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City | DANA POINT
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State | CA
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Zip | 92629-2849
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Country | US
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Telephone | 949-291-1283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JENNIFER ANN TELFORD
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Credential | MSK
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Telephone | 949-291-1283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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