Provider Demographics
NPI:1134883549
Name:REMPOJO, JELISSA (LMFT)
Entity type:Individual
Prefix:
First Name:JELISSA
Middle Name:
Last Name:REMPOJO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JOJO
Other - Middle Name:
Other - Last Name:REMPOJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:615 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4447
Mailing Address - Country:US
Mailing Address - Phone:707-599-7366
Mailing Address - Fax:707-407-0566
Practice Address - Street 1:615 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4447
Practice Address - Country:US
Practice Address - Phone:707-599-7366
Practice Address - Fax:707-407-0566
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT128504OtherREGISTRATION NO