Provider Demographics
NPI:1154884880
Name:GIRALICO-WYMAN, JANETTE (AMFT)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:GIRALICO-WYMAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 UPPER LAKE CT
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7335
Mailing Address - Country:US
Mailing Address - Phone:530-966-8212
Mailing Address - Fax:
Practice Address - Street 1:15 ILAHEE LN STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7205
Practice Address - Country:US
Practice Address - Phone:530-966-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty