Provider Demographics
NPI:1962993725
Name:STECK, JARED LEE (HIGH SCHOOL DIPLOMA)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:LEE
Last Name:STECK
Suffix:
Gender:M
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 JACKSON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-6804
Mailing Address - Country:US
Mailing Address - Phone:650-960-1560
Mailing Address - Fax:
Practice Address - Street 1:3610 SNELL AVE # CA95136
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-1305
Practice Address - Country:US
Practice Address - Phone:408-618-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF8619331106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician