Provider Demographics
NPI:1750789293
Name:WHARTON, JESSICA (LMFT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 25TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1810
Mailing Address - Country:US
Mailing Address - Phone:916-842-0343
Mailing Address - Fax:
Practice Address - Street 1:1990 3RD ST
Practice Address - Street 2:SUITE 900
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6929
Practice Address - Country:US
Practice Address - Phone:916-842-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist