Provider Demographics
NPI:1326570482
Name:CODY, JESSICA (MASTER OF ARTS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:MASTER OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 CROSSROADS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3391
Mailing Address - Country:US
Mailing Address - Phone:405-319-0119
Mailing Address - Fax:405-676-1146
Practice Address - Street 1:3986 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7202
Practice Address - Country:US
Practice Address - Phone:405-973-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX93247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor