Provider Demographics
NPI:1659982866
Name:TICHENOR, JESSE MICHAEL (AMFT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:MICHAEL
Last Name:TICHENOR
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 STRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2609
Mailing Address - Country:US
Mailing Address - Phone:510-883-3463
Mailing Address - Fax:
Practice Address - Street 1:1250 PINE ST STE 102
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3633
Practice Address - Country:US
Practice Address - Phone:510-883-3463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAAMFT122416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program