Provider Demographics
NPI:1821829995
Name:BATES, JESSICA RENEE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RENEE
Last Name:BATES
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 PALOMAR AIRPORT RD STE 170
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1489
Mailing Address - Country:US
Mailing Address - Phone:760-942-8663
Mailing Address - Fax:
Practice Address - Street 1:2121 PALOMAR AIRPORT RD STE 170
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1489
Practice Address - Country:US
Practice Address - Phone:760-942-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist