Provider Demographics
NPI:1306417191
Name:JESSUP, MEREDITH ASHLEY (LMSW, LCDC)
Entity Type:Individual
Prefix:MISS
First Name:MEREDITH
Middle Name:ASHLEY
Last Name:JESSUP
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 S UECKER LN APT 316
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7838
Mailing Address - Country:US
Mailing Address - Phone:269-689-2167
Mailing Address - Fax:
Practice Address - Street 1:8222 DOUGLAS AVE STE 375
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5973
Practice Address - Country:US
Practice Address - Phone:214-905-5090
Practice Address - Fax:214-905-1998
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14576101YA0400X
TX632421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)