Provider Demographics
NPI:1801165220
Name:BOLET, JESSICA (LPCC, PPS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BOLET
Suffix:
Gender:F
Credentials:LPCC, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9381 AMSDEN WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-3013
Mailing Address - Country:US
Mailing Address - Phone:951-445-9382
Mailing Address - Fax:
Practice Address - Street 1:27710 JEFFERSON AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4604
Practice Address - Country:US
Practice Address - Phone:951-394-1490
Practice Address - Fax:951-339-3341
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1452101YP2500X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional