Provider Demographics
NPI:1326301839
Name:CISNEROS, JESSICA (MED, LPC, BCC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MED, LPC, BCC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CHAPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4625 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5544
Mailing Address - Country:US
Mailing Address - Phone:713-861-4849
Mailing Address - Fax:
Practice Address - Street 1:4625 LILLIAN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5544
Practice Address - Country:US
Practice Address - Phone:713-861-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional