Provider Demographics
NPI:1346792942
Name:TIEGS, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TIEGS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 E LA CHOZA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5305
Mailing Address - Country:US
Mailing Address - Phone:310-525-7598
Mailing Address - Fax:
Practice Address - Street 1:4526 E LA CHOZA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5305
Practice Address - Country:US
Practice Address - Phone:310-525-7598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-30
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84367106H00000X
AZLMFT-15598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist