Individual ProviderJan SlackMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address5480 Baltimore Dr, Ste. 202, La Mesa, CA 91942-2020(619) 335-5373PECOS EnrollmentBased on the most recent information from CMS, provider Jan Slack is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1083791271Provider TypeIndividualFull NameSlack, JanTitleMs.CredentialMFTGenderFemaleSole ProprietorYesEnumeration Date11/1/2006Last Updated7/16/2010Contact InformationPractice LocationPractice Address5480 Baltimore Dr, Ste. 202, La Mesa, CA 91942-2020Phone(619) 335-5373Fax(619) 464-7772Mailing LocationMailing Address5480 Baltimore Dr, Ste. 202, La Mesa, CA 91942-2020Phone(619) 335-5373Fax(619) 464-7772Provider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC47977CaliforniaProvider IdentifiersIDDescriptionIssuerID9235DescriptionOtherIssuerMEDICALCalifornia