Provider Demographics
NPI:1487701074
Name:FAULKNER, JEANNE ELISE (LMFT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:ELISE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:GISSENAAS
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5755 COTTLE RD
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3640
Mailing Address - Country:US
Mailing Address - Phone:408-972-3227
Mailing Address - Fax:408-972-3242
Practice Address - Street 1:5755 COTTLE RD
Practice Address - Street 2:BUILDING 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3640
Practice Address - Country:US
Practice Address - Phone:408-972-3227
Practice Address - Fax:408-972-3242
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 21376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist