Provider Demographics
NPI:1932588076
Name:TEMPLE, JASON S (MA, LMFT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:S
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19322 JESSE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5072
Mailing Address - Country:US
Mailing Address - Phone:951-387-4040
Mailing Address - Fax:951-398-3144
Practice Address - Street 1:19330 JESSE LN # 280
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5091
Practice Address - Country:US
Practice Address - Phone:951-387-4040
Practice Address - Fax:951-398-3144
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA81243106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health