Provider Demographics
NPI:1578259222
Name:EDWARDS, JESSICA JAZMIN (MA, AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JAZMIN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1001
Mailing Address - Country:US
Mailing Address - Phone:714-306-8971
Mailing Address - Fax:
Practice Address - Street 1:2102 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-1001
Practice Address - Country:US
Practice Address - Phone:714-306-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist