Provider Demographics
NPI:1366506750
Name:BARRETT, JESSICA (MFT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 LONGRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:91401-3148
Mailing Address - Country:US
Mailing Address - Phone:818-784-8426
Mailing Address - Fax:818-989-0997
Practice Address - Street 1:6113 LONGRIDGE AVE
Practice Address - Street 2:
Practice Address - City:VALLEY GLEN
Practice Address - State:CA
Practice Address - Zip Code:91401-3148
Practice Address - Country:US
Practice Address - Phone:818-784-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18183101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health