Healthcare Provider Details

I. General information

NPI: 1821572520
Provider Name (Legal Business Name): JEWELISA HARRISON-KAYODE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEWELISA HARRISON

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST STE C
MODESTO CA
95350-5814
US

IV. Provider business mailing address

100 POPLAR AVE
MODESTO CA
95354-0510
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number135837
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: