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General NPI Number Information
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NPI Number | 1376924860
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Entity Type | Organization
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Legal Business Name | JESSICA ENGLE
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 1265 65TH ST
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City | EMERYVILLE
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State | CA
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Zip | 94608-1110
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Country | US
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Telephone | 408-622-1000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8642
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City | EMERYVILLE
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State | CA
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Zip | 94662-0642
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Country | US
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Telephone | 408-622-1000
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST AND COACH
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Name | JESSICA ANNE ENGLE
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Credential | MA
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Telephone | 408-622-1000
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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 | 81850
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License Number State | CA
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