Provider Demographics
NPI:1861971285
Name:SEVIM, JACQUELYNN BROOKE (LMFT, PHD)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:BROOKE
Last Name:SEVIM
Suffix:
Gender:F
Credentials:LMFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 STUART AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1519
Mailing Address - Country:US
Mailing Address - Phone:661-205-6000
Mailing Address - Fax:
Practice Address - Street 1:1107 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3303
Practice Address - Country:US
Practice Address - Phone:661-205-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83994101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty