Provider Demographics
NPI:1104381995
Name:GALBREATH, JACQUELYN RODGERS (MFT, PHD)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:RODGERS
Last Name:GALBREATH
Suffix:
Gender:F
Credentials:MFT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MULLINIX WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-3775
Mailing Address - Country:US
Mailing Address - Phone:831-459-2628
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95192-1077
Practice Address - Country:US
Practice Address - Phone:408-294-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty