Provider Demographics
NPI:1659478568
Name:ST.CLAIR, JESSICA JONES (MFT)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JONES
Last Name:ST.CLAIR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2162
Mailing Address - Country:US
Mailing Address - Phone:714-227-2420
Mailing Address - Fax:714-568-1111
Practice Address - Street 1:5015 BIRCH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2162
Practice Address - Country:US
Practice Address - Phone:714-227-2420
Practice Address - Fax:714-568-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 33138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330832339Medicaid