Healthcare Provider Details

I. General information

NPI: 1245787779
Provider Name (Legal Business Name): JESSICA M NOLASCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD SUITE 300
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

325 9TH AVE
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax: 213-481-7147
Mailing address:
  • Phone: 206-744-5508
  • Fax: 206-744-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW62554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: