Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ASW68402 | CA |
NPI | 1003249525 |
---|---|
Provider Name | Jessica Ehlers |
First Address | Fort Bragg, CA 95437-5708 |
Second Address | Fort Bragg, CA 95437-5708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 12/01/2017 |