Provider Demographics
NPI:1538182746
Name:MARQUIS, JEANINE LOUISE (MFT)
Entity type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:LOUISE
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W HOSPITALITY LN
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3210
Mailing Address - Country:US
Mailing Address - Phone:909-285-6495
Mailing Address - Fax:909-792-4495
Practice Address - Street 1:325 W HOSPITALITY LN
Practice Address - Street 2:STE 110
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3210
Practice Address - Country:US
Practice Address - Phone:909-285-6495
Practice Address - Fax:909-792-4495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC20618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist