MEDICARE: JESSICA REYNOLDS LMFT

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	131144	CA

General Provider Information

NPI Number	:	1801679485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA REYNOLDS LMFT

Provider Business Mailing Address
First Line	:	132 SEGRE PL
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	730 MISSION ST STE 202
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-3689
Country	:	US
Telephone Number	:	831-216-8744
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/16/2023

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