Provider Demographics
NPI:1922518489
Name:JESSUP, INC
Entity Type:Organization
Organization Name:JESSUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-801-7882
Mailing Address - Street 1:1642 N VOLUSIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-3850
Mailing Address - Country:US
Mailing Address - Phone:386-628-0295
Mailing Address - Fax:386-243-4581
Practice Address - Street 1:1642 N VOLUSIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-3850
Practice Address - Country:US
Practice Address - Phone:386-628-0295
Practice Address - Fax:386-243-4581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty