Provider Demographics
NPI:1174776926
Name:JESTER, SUSAN G (MFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:JESTER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S GLASSELL ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1434
Mailing Address - Country:US
Mailing Address - Phone:714-628-0456
Mailing Address - Fax:714-744-7879
Practice Address - Street 1:134 S GLASSELL ST
Practice Address - Street 2:SUITE I
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1434
Practice Address - Country:US
Practice Address - Phone:714-628-0456
Practice Address - Fax:714-744-7879
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist