Healthcare Provider Details

I. General information

NPI: 1104352590
Provider Name (Legal Business Name): JESSICA SCHULMAN EDELSTEIN LMFT, ATR, CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 02/19/2022
Certification Date: 02/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 MELROSE AVE STE 3-399
LOS ANGELES CA
90038-3756
US

IV. Provider business mailing address

5870 MELROSE AVE STE 3-399
LOS ANGELES CA
90038-3756
US

V. Phone/Fax

Practice location:
  • Phone: 424-634-1484
  • Fax:
Mailing address:
  • Phone: 424-634-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number15-195
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: