Provider Demographics
NPI:1063155596
Name:MARSH, JAYNE M (LMFT)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:M
Last Name:MARSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2312
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95038-2312
Mailing Address - Country:US
Mailing Address - Phone:408-858-8255
Mailing Address - Fax:
Practice Address - Street 1:3880 S BASCOM AVE STE 216
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2675
Practice Address - Country:US
Practice Address - Phone:408-236-2111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
84356106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist