Provider Demographics
NPI:1477078509
Name:OCHOA, JERRY (LPCC)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:OCHOA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GCDF, BC-TMH
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95381-0921
Mailing Address - Country:US
Mailing Address - Phone:209-985-6332
Mailing Address - Fax:
Practice Address - Street 1:4312 PASADERA WAY
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-8636
Practice Address - Country:US
Practice Address - Phone:209-985-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC6283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC6283OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES