Provider Demographics
NPI:1043599145
Name:BEDELL, JESSICA ELLEN (LMHC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ELLEN
Last Name:BEDELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 YOUNGS RD APT F
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2688
Mailing Address - Country:US
Mailing Address - Phone:716-870-4747
Mailing Address - Fax:
Practice Address - Street 1:4242 RIDGE LEA ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2688
Practice Address - Country:US
Practice Address - Phone:716-870-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003251-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health