MEDICARE: MS. JESSICA JONES ST.CLAIR MFT

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
1	101YM0800X	Mental Health Counselor	MFT 33138	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659478568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA JONES ST.CLAIR MFT

Provider Business Mailing Address
First Line	:	5015 BIRCH ST
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2162
Country	:	US
Telephone Number	:	714-227-2420
Fax Number	:	714-568-1111

Provider Business Practice Location Address
First Line	:	5015 BIRCH ST
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2162
Country	:	US
Telephone Number	:	714-227-2420
Fax Number	:	714-568-1111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/09/2007

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