Provider Demographics
NPI:1811163116
Name:LESTER, JEAN (MS, MFC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:LESTER
Suffix:
Gender:F
Credentials:MS, MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 SAN VICENTE BLVD
Mailing Address - Street 2:#201
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1731
Mailing Address - Country:US
Mailing Address - Phone:310-394-5579
Mailing Address - Fax:310-394-4299
Practice Address - Street 1:446 SAN VICENTE BLVD
Practice Address - Street 2:#201
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-1731
Practice Address - Country:US
Practice Address - Phone:310-394-5579
Practice Address - Fax:310-394-4299
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 13383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 13383OtherMARRIAGE AND FAMILY THERAPIST LICENSE - CALIFORNIA