Healthcare Provider Details

I. General information

NPI: 1811299563
Provider Name (Legal Business Name): JENNIE LEE BASARICH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HUERTA PL
DAVIS CA
95616-0270
US

IV. Provider business mailing address

103 HUERTA PL
DAVIS CA
95616-0270
US

V. Phone/Fax

Practice location:
  • Phone: 707-477-8957
  • Fax: 530-564-3280
Mailing address:
  • Phone: 707-477-8957
  • Fax: 530-564-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: