Provider Demographics
NPI:1376109041
Name:LOVEGOOD, JESSEE NOVA
Entity Type:Individual
Prefix:
First Name:JESSEE
Middle Name:NOVA
Last Name:LOVEGOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLYNN
Other - Middle Name:MICHELLE
Other - Last Name:JESSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94543-0573
Mailing Address - Country:US
Mailing Address - Phone:510-214-2804
Mailing Address - Fax:
Practice Address - Street 1:560 1ST ST STE A203
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3299
Practice Address - Country:US
Practice Address - Phone:510-214-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist