Provider Demographics
NPI:1063757920
Name:MORAN, JESSICA RAE (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:MORAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CHARDONNAY CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7820
Mailing Address - Country:US
Mailing Address - Phone:909-518-6455
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2635
Practice Address - Country:US
Practice Address - Phone:442-222-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72650106H00000X
CA85864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist