Provider Demographics
NPI:1851267397
Name:JESSICA POURANFAR LLC
Entity type:Organization
Organization Name:JESSICA POURANFAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MUSIC THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:POURANFAR
Authorized Official - Suffix:
Authorized Official - Credentials:MT-BC
Authorized Official - Phone:502-269-7467
Mailing Address - Street 1:1700 N MERIDIAN RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-5646
Mailing Address - Country:US
Mailing Address - Phone:229-400-0722
Mailing Address - Fax:
Practice Address - Street 1:1700 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5646
Practice Address - Country:US
Practice Address - Phone:229-400-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty