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General NPI Number Information
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NPI Number | 1225744428
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Entity Type | Individual
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Provider Name | JESSICA LYNN LATOUR
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 03/02/2023
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Provider Practice Location Address
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Address Line | 3450 3RD ST STE 1C
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City | SAN FRANCISCO
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State | CA
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Zip | 94124-1444
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Country | US
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Telephone | 415-437-3990
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Fax | 415-437-3994
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Provider Business Mailing Address
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Address Line | 2201 SHORELINE DR UNIT 6432
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City | ALAMEDA
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State | CA
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Zip | 94501-5074
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Country | US
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Telephone | 510-650-5494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 135893
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License Number State | CA
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