Provider Demographics
NPI:1225350184
Name:HIGGINS, JESSICA (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HIGGINS PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1187 COAST VILLAGE RD
Mailing Address - Street 2:#150
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2737
Mailing Address - Country:US
Mailing Address - Phone:303-506-8057
Mailing Address - Fax:
Practice Address - Street 1:1187 COAST VILLAGE RD
Practice Address - Street 2:#150
Practice Address - City:MONTECITO
Practice Address - State:CA
Practice Address - Zip Code:93108-2737
Practice Address - Country:US
Practice Address - Phone:303-506-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5464101Y00000X
CO3991103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist