Provider Demographics
NPI:1679982789
Name:SEVERIN, JEREMY KEITH (COUNSELOR MENTAL H)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:KEITH
Last Name:SEVERIN
Suffix:
Gender:M
Credentials:COUNSELOR MENTAL H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WHITE AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0491
Mailing Address - Country:US
Mailing Address - Phone:209-200-6561
Mailing Address - Fax:
Practice Address - Street 1:260 COHASSET RD STE 130
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2283
Practice Address - Country:US
Practice Address - Phone:209-200-6561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health