Provider Demographics
NPI:1942036975
Name:WALLING, JESSICA MORGAN (AMFT/APCC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:WALLING
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:CA
Mailing Address - Zip Code:95666-0795
Mailing Address - Country:US
Mailing Address - Phone:209-257-1980
Mailing Address - Fax:
Practice Address - Street 1:601 COURT ST STE 210
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2163
Practice Address - Country:US
Practice Address - Phone:209-257-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT144347106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist