MEDICARE: PRISCILLA JOUVIN PSYCHOTHERAPY

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
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1760264782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISCILLA JOUVIN PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	11760 CARMEL CREEK RD # F305
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6754
Country	:	US
Telephone Number	:	909-523-4191
Fax Number	:

Provider Business Practice Location Address
First Line	:	11760 CARMEL CREEK RD # F305
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6754
Country	:	US
Telephone Number	:	909-523-4191
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND LMFT
Name	:	PRISCILLA JOUVIN
Credential	:	MS, LMFT
Telephone Number	:	909-532-4191

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	10/16/2023

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