Provider Demographics
NPI:1538777867
Name:MAILES, JEFFREY MCDOWELL
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MCDOWELL
Last Name:MAILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 CALLE ANDALUCIA
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-1123
Mailing Address - Country:US
Mailing Address - Phone:818-926-5237
Mailing Address - Fax:
Practice Address - Street 1:403 E MONTECITO ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1759
Practice Address - Country:US
Practice Address - Phone:805-874-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty