Basic Information
| Provider Information | |||||||||
| NPI: | 1437528213 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LO | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | BUI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 210102 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259332627 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 210102 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259332627 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2015 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 93531 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 111509 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.