Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1962052522 |
---|---|
Provider Name | Jessica Kussman |
First Address | Torrance, CA 90502-4418 |
Second Address | Torrance, CA 90502-4418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 03/02/2020 |