Provider Demographics
NPI:1295101061
Name:BUSHMEYER, JESSICA ELAINE (MS)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELAINE
Last Name:BUSHMEYER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 E GRIFFITH ST
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-6290
Mailing Address - Country:US
Mailing Address - Phone:626-224-1532
Mailing Address - Fax:626-974-8198
Practice Address - Street 1:510 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3017
Practice Address - Country:US
Practice Address - Phone:626-974-8123
Practice Address - Fax:626-974-8198
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist