Provider Demographics
NPI:1962198457
Name:MORRISSETTE, JESSICA
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:MORRISSETTE
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 1:29621 BENJAMIN DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-4484
Mailing Address - Country:US
Mailing Address - Phone:813-696-2505
Mailing Address - Fax:
Practice Address - Street 1:17815 HUNTING BOW CIR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5401
Practice Address - Country:US
Practice Address - Phone:813-491-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician