Healthcare Provider Details

I. General information

NPI: 1992635163
Provider Name (Legal Business Name): WULSIN MARRIAGE, FAMILY, AND CHILD THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

31 S SUNSET DR
LODI CA
95240-2832
US

IV. Provider business mailing address

31 S SUNSET DR
LODI CA
95240-2832
US

V. Phone/Fax

Practice location:
  • Phone: 415-420-2535
  • Fax:
Mailing address:
  • Phone: 415-420-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA ROSE WULSIN
Title or Position: OWNER
Credential: LMFT
Phone: 415-420-2535