Provider Demographics
NPI:1093224537
Name:GARREN, JESSICA ROBYN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROBYN
Last Name:GARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15561 CASCADE LOOP
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8841
Mailing Address - Country:US
Mailing Address - Phone:530-273-5440
Mailing Address - Fax:
Practice Address - Street 1:15561 CASCADE LOOP
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8841
Practice Address - Country:US
Practice Address - Phone:530-273-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health