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Individual
JESSICA TICAS DESTA
Active
Individual
JESSICA TICAS DESTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
ASW104296
CA
101YM0800X
Mental Health Counselor
Primary
LCSW138913
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
08/31/2020
Last updated
09/02/2026
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