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Organization
RESTORING FAMILY HARMONY
Active
Organization
RESTORING FAMILY HARMONY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JILL JEFFERS CLARK PHD. (CLINICAL PSYCHOLOGIST)
(916) 739-1926
Entity
Organization
Contact information
Practice address
874 57TH ST, SACRAMENTO, CA 95819-3327
(916) 739-1926
(916) 739-1591
Mailing address
874 57TH ST, SACRAMENTO, CA 95819-3327
(916) 739-1926
(916) 739-1591
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY 20715
CA
103TC0700X
Clinical Psychologist
Primary
PSY 20715
CA
103TF0000X
Family Psychologist
PSY 20715
CA
1041C0700X
Clinical Social Worker
LCS 24412
CA
106H00000X
Marriage & Family Therapist
MFC 36061
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN319A
MEDICARE PTAN
CA
Enumeration date
08/11/2010
Last updated
08/11/2010
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