Provider Demographics
NPI:1932348224
Name:TAMPLEN, JESSE D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:D
Last Name:TAMPLEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1547 PALOS VERDES MALL
Mailing Address - Street 2:PMB218
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2228
Mailing Address - Country:US
Mailing Address - Phone:510-725-2427
Mailing Address - Fax:
Practice Address - Street 1:1547 PALOS VERDES MALL
Practice Address - Street 2:PMB218
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-2228
Practice Address - Country:US
Practice Address - Phone:510-725-2427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA233981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical