Provider Demographics
NPI:1912914060
Name:ERKENBECK, JEFF BLAINE (PSYD, MFT)
Entity type:Individual
Prefix:DR
First Name:JEFF
Middle Name:BLAINE
Last Name:ERKENBECK
Suffix:
Gender:M
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT STE 102
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1807
Mailing Address - Country:US
Mailing Address - Phone:619-390-1598
Mailing Address - Fax:204-441-9909
Practice Address - Street 1:3252 HOLIDAY CT STE 102
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1807
Practice Address - Country:US
Practice Address - Phone:619-390-1598
Practice Address - Fax:204-441-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist