Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1124157789 |
---|---|
Provider Name | Jonathan Depeyer |
First Address | South Pasadena, CA 91030-2630 |
Second Address | South Pasadena, CA 91030-2630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 08/07/2007 |