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NPI Code Detail

MEDICARE: JEANNINE BLEAM MEALEY LMFT

MEDICARE: JEANNINE BLEAM MEALEY LMFT
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 TherapistMFC38405CA
2101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14733OTHERCASCC ID

General Provider Information

NPI Number : 1770673584
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNINE BLEAM MEALEY LMFT
Provider Business Mailing Address
First Line : PO BOX 16
Second Line :
City : BOULDER CREEK
State : CA
Zip : 95006-0016
Country : US
Telephone Number : 408-364-4009
Fax Number :
Provider Business Practice Location Address
First Line : 225 37TH AVE
Second Line :
City : SAN MATEO
State : CA
Zip : 94403-4324
Country : US
Telephone Number : 650-573-3659
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 06/12/2012

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