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General NPI Number Information
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NPI Number | 1629716188
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Entity Type | Individual
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Provider Name | GINA JURKOTA NCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 2271 W LOUISE AVE
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City | MANTECA
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State | CA
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Zip | 95337-8381
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Country | US
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Telephone | 209-825-3200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | NEWARK
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State | NJ
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Zip | 07101-0553
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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 | TPMC2090
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License Number State | FL
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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 | 11199
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37PC00847900
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License Number State | NJ
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