Provider Demographics
NPI:1659771541
Name:PIERCE, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:PIERCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 SEA SPRAY LN
Mailing Address - Street 2:#306
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-2434
Mailing Address - Country:US
Mailing Address - Phone:909-747-5117
Mailing Address - Fax:
Practice Address - Street 1:815 SEA SPRAY LN
Practice Address - Street 2:#306
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-2434
Practice Address - Country:US
Practice Address - Phone:909-747-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health