Basic Information
| Provider Information | |||||||||
| NPI: | 1760854616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENNY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JULIA | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 788 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939011310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312621394 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1441 CONSTITUTION BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939063127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317961700 | ||||||||
| FaxNumber: | 8317690552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2015 | ||||||||
| LastUpdateDate: | 06/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | PCCI2282 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LPCC8825 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | IMF88026 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 112634 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.