MR. JACK SHIELDS COUSINEAU (NPI# 1548570583) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548570583 |
| Entity Type | Individual |
| Full Name | MR. JACK SHIELDS COUSINEAU |
| Credential | LMFT |
| Practice Address |
3700 Delta Fair Blvd Ste 201a Antioch CA 94509-4073 |
| Mailing Address |
Po Box 697 Hayward CA 94543-0697 |
| Practice Telephone | 5108097350 |
| Practice Fax Number | 8556475562 |
| Mailing Telephone | 6267107915 |
| Mailing Fax Number | 8556475562 |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2018-10-15 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | LMFT90191 | CA | Behavioral Health & Social Service Providers |
| Street Address |
3700 DELTA FAIR BLVD STE 201A |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94509-4073 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932733243 | A Step Above, LLC | Clinic/Center | 3648 Delta Fair Blvd., Antioch, CA 94509 | 2020-02-25 |
| 1134751167 | Dr. Jeffrey A Saladin, Dental Corporation | Dentist | 3600 Delta Fair Blvd, Antioch, CA 94509 | 2020-02-07 |
| 1962040865 | Melay Goitom | Behavioral Analyst | 3104 Delta Fair Boulevard, Antioch, CA 94509 | 2019-12-11 |
| 1518525062 | James Joseph Cook | Counselor | 624 W. 14th Street B, Antioch, CA 94509 | 2019-05-30 |
| 1922576438 | Wazma Matiee | Behavioral Analyst | 2009 Asilomar Dr., Antioch, CA 94509 | 2018-11-02 |
| 1346722360 | Dharma Rachelle Yancy | Behavioral Analyst | 3401 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1912489931 | Cristian Cruz | Behavioral Analyst | 3100-3104 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1780174052 | Melissa Sue Rossi | Counselor | 3701 Lone Tree Way Ste 7a, Antioch, CA 94509 | 2018-05-13 |
| 1033638085 | Elizabeth Marie Artola | Counselor | 1915 D Street, Antioch, CA 94509 | 2017-09-11 |
| 1144748690 | Andrea Michelle Newberry | Counselor | 55 E.18th St, Antioch, CA 94509 | 2017-09-05 |
| Find all providers in zip 94509 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356706808 | Joanna Posada | Marriage & Family Therapist | 1801 Mount Silliman Way, Antioch, CA 94531-8805 | 2015-12-29 |
| 1740612738 | Genoveva Vargas | Marriage & Family Therapist | 4524 Roebuck Way, Antioch, CA 94531-7647 | 2013-08-01 |
| 1396010914 | Richard C Hanzy | Marriage & Family Therapist | 3105 Lone Tree Way Ste B, Antioch, CA 94509-4974 | 2012-03-14 |
| 1659680049 | Theresa Juanita Hart | Marriage & Family Therapist | 2116 Silverado Dr, Antioch, CA 94509-5844 | 2010-10-01 |
| 1467788737 | Paul Juranovich | Marriage & Family Therapist | 1413 F St, Portable 1, Antioch, CA 94509-2220 | 2009-10-21 |
| 1548593833 | Timothy Patrick Ford | Marriage & Family Therapist | 55 E 18th St, Antioch, CA 94509-2450 | 2009-09-17 |
| 1134361330 | Cuidonce Luciana Corona | Marriage & Family Therapist | 1413 F St Bldg 1, Antioch, CA 94509-2220 | 2009-04-02 |
| 1265632095 | Carroll Ann Adams | Marriage & Family Therapist | 621 W 2nd St Ste 245, Antioch, CA 94509-1282 | 2007-07-19 |
| 1609075498 | Tanya Michelle Ford-goins | Marriage & Family Therapist | 3701 Lone Tree Way Ste 7, Antioch, CA 94509 | 2007-07-12 |
| 1174729610 | Kelly Jean Lowry | Marriage & Family Therapist | 2225 Buchanan Rd Ste C, Antioch, CA 94509-4209 | 2007-06-22 |
| Find all providers in ANTIOCH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.