Healthcare Provider Details

I. General information

NPI: 1851877880
Provider Name (Legal Business Name): JESSICA MACIAS-CERVANTES ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 F ST
WASCO CA
93280
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-7319
  • Fax: 661-758-7303
Mailing address:
  • Phone: 661-758-7321
  • Fax: 661-758-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACSW117691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: