Basic Information
| Provider Information | |||||||||
| NPI: | 1720412125 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COOMBS | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ELWELL CT STE 230 | ||||||||
| Address2: | |||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943034306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506818868 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 CABRILLO HWY S | ||||||||
| Address2: | |||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940198200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507266369 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2013 | ||||||||
| LastUpdateDate: | 10/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | LMFT119407 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.