Provider Demographics
NPI:1073951364
Name:CASTANEDA, JESSICA RYAN DAVIDSON (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RYAN DAVIDSON
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:4060 WATSON PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-4033
Mailing Address - Country:US
Mailing Address - Phone:213-399-4224
Mailing Address - Fax:
Practice Address - Street 1:5190 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6510
Practice Address - Country:US
Practice Address - Phone:562-428-4111
Practice Address - Fax:562-984-5461
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74386106H00000X
CA106755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist