Provider Demographics
NPI:1427727106
Name:LIBAN-ORTANEZ, JAMIL MOISES (AMFT)
Entity type:Individual
Prefix:
First Name:JAMIL MOISES
Middle Name:
Last Name:LIBAN-ORTANEZ
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 WHITTLE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2442
Mailing Address - Country:US
Mailing Address - Phone:916-832-1079
Mailing Address - Fax:
Practice Address - Street 1:325 VERNON ST APT 304
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3003
Practice Address - Country:US
Practice Address - Phone:916-832-1079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134479106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist