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General NPI Number Information
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NPI Number | 1285997866
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Entity Type | Individual
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Provider Name | JESSICA LAUREN WHITEHEAD LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4419 VAN NUYS BLVD STE 406
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-5743
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Country | US
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Telephone | 818-406-6327
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 431
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City | WOODLAND HILLS
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State | CA
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Zip | 91365-0431
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 97233
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 97233
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License Number State | CA
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