Provider Demographics
NPI:1013213842
Name:IMMITT, JESSICA CYPRESS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CYPRESS
Last Name:IMMITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 E ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1856
Mailing Address - Country:US
Mailing Address - Phone:707-498-3809
Mailing Address - Fax:
Practice Address - Street 1:808 E ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1856
Practice Address - Country:US
Practice Address - Phone:707-498-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA759001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical