Provider Demographics
NPI:1912798331
Name:WEBSTER, JASON EDWARD (COUNSELOR)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:E
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SUDCC
Mailing Address - Street 1:3619 N MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:90031-3136
Mailing Address - Country:US
Mailing Address - Phone:213-721-0010
Mailing Address - Fax:
Practice Address - Street 1:3619 N MISSION RD
Practice Address - Street 2:
Practice Address - City:LINCOLN HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:90031-3136
Practice Address - Country:US
Practice Address - Phone:213-721-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19172101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)