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General NPI Number Information
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NPI Number | 1407474745
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Entity Type | Individual
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Provider Name | JESSICA MARIE ROUX AMFT
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Gender | Female
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 8140 SUNLAND BLVD
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City | SUN VALLEY
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State | CA
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Zip | 91352-3948
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Country | US
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Telephone | 818-582-8832
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Fax | 818-582-8836
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Provider Business Mailing Address
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Address Line | 824 S ORANGE GROVE AVE APT 15
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City | LOS ANGELES
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State | CA
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Zip | 90036-4473
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Country | US
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Telephone | 310-409-6116
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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 | 118552
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License Number State | CA
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