Provider Demographics
NPI:1023639788
Name:GIRALDO, JANIEL VEBEKE (AMFT)
Entity type:Individual
Prefix:
First Name:JANIEL
Middle Name:VEBEKE
Last Name:GIRALDO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W CLARK ST APT A
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-5312
Mailing Address - Country:US
Mailing Address - Phone:707-205-7787
Mailing Address - Fax:
Practice Address - Street 1:1 HARPST ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-8299
Practice Address - Country:US
Practice Address - Phone:707-826-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA114584OtherASSOCIATE MARRIAGE AND FAMILY THERAPIST