Healthcare Provider Details

I. General information

NPI: 1558406389
Provider Name (Legal Business Name): JESSICA JOY LUCKEY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 ROLANDO KNOLLS DR
LA MESA CA
91942-5823
US

IV. Provider business mailing address

6900 ROLANDO KNOLLS DR
LA MESA CA
91942-5823
US

V. Phone/Fax

Practice location:
  • Phone: 619-520-0485
  • Fax:
Mailing address:
  • Phone: 619-520-0485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 42521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: