Provider Demographics
NPI:1649557612
Name:BARRERA, JESSICA AMANDA
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:AMANDA
Last Name:BARRERA
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 1:18302 IRVINE BLVD
Mailing Address - Street 2:300
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3435
Mailing Address - Country:US
Mailing Address - Phone:714-438-9959
Mailing Address - Fax:
Practice Address - Street 1:18302 IRVINE BLVD
Practice Address - Street 2:300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3435
Practice Address - Country:US
Practice Address - Phone:714-438-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor