Provider Demographics
NPI:1043964430
Name:WILSON, JESSICA RENE'E (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENE'E
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HEBRON PKWY STE 803
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-5145
Mailing Address - Country:US
Mailing Address - Phone:940-580-9689
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 803
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5145
Practice Address - Country:US
Practice Address - Phone:940-580-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist