Healthcare Provider Details

I. General information

NPI: 1710694021
Provider Name (Legal Business Name): JESSICA JUNE KEYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PINE AVE STE 609
LONG BEACH CA
90802-2310
US

IV. Provider business mailing address

320 PINE AVE STE 609
LONG BEACH CA
90802-2310
US

V. Phone/Fax

Practice location:
  • Phone: 562-279-0180
  • Fax: 562-661-9672
Mailing address:
  • Phone: 562-279-0180
  • Fax: 562-661-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: