Provider Demographics
NPI:1326567256
Name:JESSUP, FELICIA KAY (LPC)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:KAY
Last Name:JESSUP
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 MILLICENT WAY APT 125
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2208
Mailing Address - Country:US
Mailing Address - Phone:318-550-8861
Mailing Address - Fax:
Practice Address - Street 1:1440 HAWN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6532
Practice Address - Country:US
Practice Address - Phone:318-226-5990
Practice Address - Fax:318-226-5994
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional