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NPI Code Detail

MEDICARE: LATOYA JACKSON AMFT

MEDICARE: LATOYA JACKSON AMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist130954CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11407660251OTHERCASFV
21629809579OTHERCAHQ
31871324046OTHERCAAV

General Provider Information

NPI Number : 1134467665
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATOYA JACKSON AMFT
Provider Business Mailing Address
First Line : 435 YALE AVE
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-4340
Country : US
Telephone Number : 909-326-0657
Fax Number :
Provider Business Practice Location Address
First Line : 435 YALE AVE
Second Line :
City : CLAREMONT
State : CA
Zip : 91711-4340
Country : US
Telephone Number : 909-575-4211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2013
Last Update Date : 03/14/2026

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