Provider Demographics
NPI:1922654961
Name:KEANE, JESSICA (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KEANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1637 E VALLEY PKWY # 2017
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2408
Mailing Address - Country:US
Mailing Address - Phone:805-901-1086
Mailing Address - Fax:
Practice Address - Street 1:16935 W BERNARDO DR STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1636
Practice Address - Country:US
Practice Address - Phone:858-324-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist