Provider Demographics
NPI:1629596846
Name:JAYNE, SKYLER JACK
Entity type:Individual
Prefix:
First Name:SKYLER
Middle Name:JACK
Last Name:JAYNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:CHRISTINE
Other - Last Name:JAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 ALAMEDA DEL PRADO STE 103
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6698
Mailing Address - Country:US
Mailing Address - Phone:415-457-6964
Mailing Address - Fax:
Practice Address - Street 1:2235 MERCURY WAY STE 107
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5472
Practice Address - Country:US
Practice Address - Phone:707-571-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor