Provider Demographics
NPI:1861530057
Name:FARRAR, JESSE
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:FARRAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MORELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4707
Mailing Address - Country:US
Mailing Address - Phone:925-812-7381
Mailing Address - Fax:
Practice Address - Street 1:1220 MORELLO AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4707
Practice Address - Country:US
Practice Address - Phone:925-812-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
373H00000X
CAC058060618101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist