Provider Demographics
NPI:1912108903
Name:JUSTIN, JUDITH ANN (LMFT)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:JUSTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:JUSTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:2518 VIA OESTE DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-9420
Mailing Address - Country:US
Mailing Address - Phone:760-451-0980
Mailing Address - Fax:
Practice Address - Street 1:2518 VIA OESTE DR
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-9420
Practice Address - Country:US
Practice Address - Phone:760-451-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist