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General NPI Number Information
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NPI Number | 1942703715
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Entity Type | Individual
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Provider Name | JERRICKSON DANIEL AJEX PALVANNAN
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Gender | Male
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Dates
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Enumeration Date | 03/17/2018
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 425 S H ST
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City | BAKERSFIELD
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State | CA
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Zip | 93304-3930
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Country | US
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Telephone | 661-364-6419
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3483
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City | BAKERSFIELD
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State | CA
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Zip | 93385-3483
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Country | US
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Telephone | 661-364-6419
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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 | AMFT127180
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC19831
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License Number State | CA
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