Provider Demographics
NPI:1609396407
Name:BROWN, JESSICA C (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2732 S BLAIRE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0062
Mailing Address - Country:US
Mailing Address - Phone:415-757-9745
Mailing Address - Fax:
Practice Address - Street 1:2732 S BLAIRE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0062
Practice Address - Country:US
Practice Address - Phone:415-757-9745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK157605106H00000X
ORT1436106H00000X
CA105959106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist