Healthcare Provider Details

I. General information

NPI: 1801165220
Provider Name (Legal Business Name): JESSICA BOLET LPCC, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27710 JEFFERSON AVE SUITE 205
TEMECULA CA
92590-4604
US

IV. Provider business mailing address

9381 AMSDEN WAY
EDEN PRAIRIE MN
55347-3013
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-1490
  • Fax: 951-339-3341
Mailing address:
  • Phone: 951-445-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: