Provider Demographics
NPI:1528378361
Name:MITTS, JESSICA LORRAINE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:MITTS
Suffix:
Gender:F
Credentials:BCBA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3731 6TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4383
Mailing Address - Country:US
Mailing Address - Phone:619-291-3515
Mailing Address - Fax:619-291-3526
Practice Address - Street 1:3731 6TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4383
Practice Address - Country:US
Practice Address - Phone:619-291-3515
Practice Address - Fax:619-291-3526
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1-09-5147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst