Provider Demographics
NPI:1497204283
Name:MAYNES, JESSICA LYNNE
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNNE
Last Name:MAYNES
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 1:560 COHASSET RD
Mailing Address - Street 2:SUITE 165
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2281
Mailing Address - Country:US
Mailing Address - Phone:530-891-2891
Mailing Address - Fax:
Practice Address - Street 1:560 COHASSET RD
Practice Address - Street 2:SUITE 165
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2281
Practice Address - Country:US
Practice Address - Phone:530-891-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool