Provider Demographics
NPI:1376966515
Name:WATERSON, JESSICA KARAS (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KARAS
Last Name:WATERSON
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 1:427 YALE AVE # 202
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4340
Mailing Address - Country:US
Mailing Address - Phone:619-818-6165
Mailing Address - Fax:
Practice Address - Street 1:3999 OLD TOWN AVE # B-100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2964
Practice Address - Country:US
Practice Address - Phone:619-818-6165
Practice Address - Fax:619-299-9089
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#53753106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist