Provider Demographics
NPI:1174351605
Name:DOVE, JUSTIN HARBOUR (EDS, NCSP, LEP #4333)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:HARBOUR
Last Name:DOVE
Suffix:
Gender:M
Credentials:EDS, NCSP, LEP #4333
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27240 TURNBERRY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1045
Mailing Address - Country:US
Mailing Address - Phone:661-261-8750
Mailing Address - Fax:
Practice Address - Street 1:27240 TURNBERRY LN STE 200
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1045
Practice Address - Country:US
Practice Address - Phone:661-261-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist