Provider Demographics
NPI:1760854616
Name:ENNY, JESSICA JULIA (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JULIA
Last Name:ENNY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-1310
Mailing Address - Country:US
Mailing Address - Phone:831-262-1394
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3127
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:831-769-0552
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-29
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI2282101YP2500X
CALPCC8825101YP2500X
CAIMF88026106H00000X
CA112634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional