Basic Information
Provider Information
NPI: 1386183739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEGASPE
FirstName: JESSICA
MiddleName: CAREN
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 201 N COURT ST
Address2:  
City: VISALIA
State: CA
PostalCode: 932914918
CountryCode: US
TelephoneNumber: 5596272046
FaxNumber: 8443684079
Practice Location
Address1: 201 N COURT ST
Address2:  
City: VISALIA
State: CA
PostalCode: 932914918
CountryCode: US
TelephoneNumber: 5596272046
FaxNumber: 8443684079
Other Information
ProviderEnumerationDate: 02/17/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X CAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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