Healthcare Provider Details

I. General information

NPI: 1972801348
Provider Name (Legal Business Name): JESSICA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E CANAL DR
TURLOCK CA
95380-3936
US

IV. Provider business mailing address

440 E CANAL DR
TURLOCK CA
95380-3936
US

V. Phone/Fax

Practice location:
  • Phone: 209-656-1487
  • Fax:
Mailing address:
  • Phone: 209-668-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: