JESSICA WALLACE - NPI 1073940888 - Marriage & Family Therapist in Poway, CA

Q: What is Jessica Wallace's NPI number?

The NPI number for Jessica Wallace is 1073940888. It was assigned to this individual provider in the NPPES registry on October 11, 2013.

Q: What is Jessica Wallace's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Q: When was this NPI record last updated?

The NPPES record for Jessica Wallace was last updated on March 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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About Jessica Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JESSICA WALLACE (NPI 1073940888) is an individual marriage & family therapist in Poway, California, licensed in California (103283) and active in the NPI registry since October 2013. She maintains a secondary practice location in La Mesa.

NPPES Registry Identity

NPI1073940888

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameJESSICA WALLACE

Location Address15611 POMERADO RD STE 535Poway, CA 92064-2437

Mailing AddressPo Box 3328Ramona, CA 92065-0957 · (858) 279-1223

Phone(858) 279-1223

Sole ProprietorNo

Enumeration DateOctober 11, 2013

Last NPPES UpdateMarch 17, 20182 updates tracked since enumeration

✔ NPI 1073940888 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 103283

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

15611 POMERADO RD STE 535, Poway, CA 92064

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Secondary Practice Location 1

Location 18376 Hercules StLA Mesa, CA 91942-2902 · Phone (619) 667-6891

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KIYANA KIANFAR-JAGODA LMFT, PSY.D

Marriage & Family Therapist