| Doctor Name: | MISS DEANEA MARIE JESSUP |
| NPI Number: | 1992079206 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ACSW |
| License Number: | |
| Business Practice Address: | 6302 Thirteenth Avenue Lucerne, CA - 954581024 |
| Business Phone Number: | 7072749101 |
| Business Fax Number: | 7072749192 |
| Mailing Address: | Po Box 1024, LUCERNE |
| State: | CA |
| Postal Code: | 954581024 |
| Phone Number: | 7072749101 |
| Fax Number: | 7072749192 |
| NPI Enumeration Date: | 03/05/2012 |
| NPI Last Update Date: | 06/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |