Provider Demographics
NPI:1326855602
Name:MOUA, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MOUA
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 1:13500 LUIS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA NELLA
Mailing Address - State:CA
Mailing Address - Zip Code:95322-9645
Mailing Address - Country:US
Mailing Address - Phone:209-854-6177
Mailing Address - Fax:
Practice Address - Street 1:13500 LUIS AVE
Practice Address - Street 2:
Practice Address - City:SANTA NELLA
Practice Address - State:CA
Practice Address - Zip Code:95322-9645
Practice Address - Country:US
Practice Address - Phone:209-854-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220172399101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool