Rebecca Jernigan, MFT INTERN

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

120558 Issued in CA

Practice address

3000 Newburg Rd Ste D
Fortuna, CA 95540-2522

Phone

(707) 268-8722

Fax

(707) 268-0218

NPI assigned

Aug 15, 2016

Last updated

Aug 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1073068417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 271",
            "city": "HYDESVILLE",
            "state": "CA",
            "postal_code": "955470271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NEWBURG RD STE D",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955402522",
            "telephone_number": "707-268-8722",
            "fax_number": "707-268-0218"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1802 California St",
            "address_purpose": "LOCATION",
            "city": "Eureka",
            "state": "CA",
            "postal_code": "955012808",
            "country_code": "US",
            "telephone_number": "707-443-7358 x316",
            "fax_number": "707-443-1092",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "REBECCA",
        "credential": "MFT INTERN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-15",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "93764",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "120558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Humboldt Neurohealth Therapeutic Services
• Humboldt Radiology Medical Group Inc
• Humboldt Senior Resource Center (Fortuna Adult Day Health Care)
• Ikigai Physician Group Inc
• Jack L. Guccione
• Sheri A Jewett, CMT
• Robert Earl Johnson, RPH
• Jones and Bellah MDS
• Jones and Hindbaugh Partnership
• Clifford Ray Jones, M.D.

• Marriage & Family Therapist in Fortuna, CA
• Providers in Fortuna, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.