Basic Information
| Provider Information | |||||||||
| NPI: | 1639377625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOUVION | ||||||||
| FirstName: | JILAYNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 440 CAJON ST | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093075777 | ||||||||
| FaxNumber: | 9093075776 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 CAJON ST | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923735955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093075777 | ||||||||
| FaxNumber: | 9093075776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY15839 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.