Healthcare Provider Details

I. General information

NPI: 1144114810
Provider Name (Legal Business Name): JEREMY URESSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 WILSHIRE BLVD STE 1150
LOS ANGELES CA
90024-4330
US

IV. Provider business mailing address

8033 W SUNSET BLVD # 133
LOS ANGELES CA
90046-2401
US

V. Phone/Fax

Practice location:
  • Phone: 424-268-0471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: