Provider Demographics
NPI:1851022594
Name:COSTELLO, JESSICA ANNE (LPCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:5086 LYNCH CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3861
Mailing Address - Country:US
Mailing Address - Phone:619-609-6287
Mailing Address - Fax:
Practice Address - Street 1:5086 LYNCH CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3861
Practice Address - Country:US
Practice Address - Phone:619-609-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional