Provider Demographics
NPI:1487767893
Name:FRANK, JERRI LYNNE (PHD MFT)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:LYNNE
Last Name:FRANK
Suffix:
Gender:F
Credentials:PHD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DUESENBERG DRIVE
Mailing Address - Street 2:#2
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-374-0446
Mailing Address - Fax:805-497-4647
Practice Address - Street 1:141 DUESENBERG DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-374-0446
Practice Address - Fax:805-497-4647
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist