Provider Demographics
NPI:1477819019
Name:AUBUCHON, JESSICA (INTERN MHC, MS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:AUBUCHON
Suffix:
Gender:F
Credentials:INTERN MHC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7182
Mailing Address - Country:US
Mailing Address - Phone:305-398-6100
Mailing Address - Fax:305-398-6099
Practice Address - Street 1:140 NW 59TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-1218
Practice Address - Country:US
Practice Address - Phone:305-759-8888
Practice Address - Fax:305-757-5989
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health