Individual
JESSICA A JACUPKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
3740 E SOUTHERN AVE STE 209, MESA, AZ 85206-2512
(480) 577-7561
Mailing address
3740 E SOUTHERN AVE STE 209, MESA, AZ 85206-2512
(480) 553-7743
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-19519
AZ
Other
Enumeration date
12/16/2018
Last updated
05/08/2023
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