MEDICARE: JESSICA PRAUSE

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1851829006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PRAUSE

Provider Business Mailing Address
First Line	:	PO BOX 5774
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92846-0774
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 N GOLDEN CIRCLE DR STE 100
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3913
Country	:	US
Telephone Number	:	714-543-0483
Fax Number	:

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

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	08/09/2017

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Directions to “ JESSICA PRAUSE ” Practice Location

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