Provider Demographics
NPI:1073802658
Name:ANSCHUTZ, JESSALEA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JESSALEA
Middle Name:
Last Name:ANSCHUTZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 W PLANO PKWY
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8601
Mailing Address - Country:US
Mailing Address - Phone:214-717-8448
Mailing Address - Fax:972-422-2711
Practice Address - Street 1:2001 W PLANO PKWY
Practice Address - Street 2:SUITE 2300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8601
Practice Address - Country:US
Practice Address - Phone:214-717-8448
Practice Address - Fax:972-422-2711
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63619101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional