Provider Demographics
NPI:1710466602
Name:YOUSEFFI, JESSICA RACHAEL (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHAEL
Last Name:YOUSEFFI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 BERKELEY WAY APT E
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-1275
Mailing Address - Country:US
Mailing Address - Phone:213-986-6939
Mailing Address - Fax:
Practice Address - Street 1:516 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5429
Practice Address - Country:US
Practice Address - Phone:213-986-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104939106H00000X, 101YM0800X
122096106H00000X
CA122096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health