Provider Demographics
NPI:1013948603
Name:LIMAS, JESSE STEVEN (MFT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:STEVEN
Last Name:LIMAS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:BURSON
Mailing Address - State:CA
Mailing Address - Zip Code:95225-0022
Mailing Address - Country:US
Mailing Address - Phone:209-601-5989
Mailing Address - Fax:209-887-2619
Practice Address - Street 1:23 W. ST. CHARLES STREET
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-601-5989
Practice Address - Fax:209-887-2619
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39827106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA353372OtherMHN PIN
CAMFT398270OtherBLUE SHIELD PIN