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NPI Code Detail

MEDICARE: MRS. JESSICA BAILEY PROFIO AMFT

MEDICARE: MRS. JESSICA BAILEY PROFIO AMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist145548CA

General Provider Information

NPI Number : 1588421747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA BAILEY PROFIO AMFT
Provider Business Mailing Address
First Line : 2000 E 4TH ST STE 110
Second Line :
City : SANTA ANA
State : CA
Zip : 92705-3907
Country : US
Telephone Number : 714-547-0885
Fax Number :
Provider Business Practice Location Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2024
Last Update Date : 01/27/2026

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