Healthcare Provider Details

I. General information

NPI: 1780534529
Provider Name (Legal Business Name): JENNIFER ULIBAS-PASCUAL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 MARIGOLD WAY
LODI CA
95242-9794
US

IV. Provider business mailing address

PO BOX 765
LODI CA
95241-0765
US

V. Phone/Fax

Practice location:
  • Phone: 916-207-5349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC20335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: