Provider Demographics
NPI:1508194788
Name:TREAT, JESSICA REBECCA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:REBECCA
Last Name:TREAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 LYTTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1335
Mailing Address - Country:US
Mailing Address - Phone:408-835-0553
Mailing Address - Fax:
Practice Address - Street 1:665 LYTTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1335
Practice Address - Country:US
Practice Address - Phone:408-835-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist