Healthcare Provider Details

I. General information

NPI: 1841592557
Provider Name (Legal Business Name): JESSIE G URRUTIA AMFT 137729
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 CHAPMAN ACE
GARDEN GROVE CA
92840
US

IV. Provider business mailing address

13222 CHAPMAN AVE
GARDEN GROVE CA
92840-4414
US

V. Phone/Fax

Practice location:
  • Phone: 855-588-1422
  • Fax:
Mailing address:
  • Phone: 855-588-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137729
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: