Provider Demographics
NPI:1285160796
Name:SCHIVLEY, JAYSON (LMFT)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:SCHIVLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1714
Mailing Address - Country:US
Mailing Address - Phone:951-897-1045
Mailing Address - Fax:
Practice Address - Street 1:308 W KELLY AVE
Practice Address - Street 2:APT D
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1817
Practice Address - Country:US
Practice Address - Phone:951-897-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98621101YM0800X
CA113179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health