Provider Demographics
NPI:1093833774
Name:MUSEITIF, JAYNE DIANA (MSMFT)
Entity type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:DIANA
Last Name:MUSEITIF
Suffix:
Gender:
Credentials:MSMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SHERMAN AVE STE 155
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4421
Mailing Address - Country:US
Mailing Address - Phone:773-217-9729
Mailing Address - Fax:999-999-9999
Practice Address - Street 1:415 HOWARD ST APT 1802
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-4057
Practice Address - Country:US
Practice Address - Phone:773-217-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000753106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist