Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003066937 |
---|---|
Provider Name | Jeanine Middleton |
First Address | Altadena, CA 91001 |
Second Address | Altadena, CA 91001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2008 |
Last Update Date | 29/09/2008 |