Provider Demographics
NPI:1588421747
Name:PROFIO, JESSICA B (AMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:B
Last Name:PROFIO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:B
Other - Last Name:PIERSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 E 4TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3907
Mailing Address - Country:US
Mailing Address - Phone:714-547-0885
Mailing Address - Fax:
Practice Address - Street 1:4760 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4820
Practice Address - Country:US
Practice Address - Phone:310-390-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist