Healthcare Provider Details

I. General information

NPI: 1912659145
Provider Name (Legal Business Name): JESSICA DENISE ZAVALA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DENISE HERRERA

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 06/27/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 PASADENA AVE
SOUTH PASADENA CA
91030-2919
US

IV. Provider business mailing address

205 PASADENA AVE
SOUTH PASADENA CA
91030-2919
US

V. Phone/Fax

Practice location:
  • Phone: 323-344-5536
  • Fax: 323-344-5550
Mailing address:
  • Phone: 323-344-5536
  • Fax: 323-344-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: