Provider Demographics
NPI:1326799818
Name:REYES, JESSICA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:REYES
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 1:6551 STAGE OAKS DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3895
Mailing Address - Country:US
Mailing Address - Phone:901-387-0026
Mailing Address - Fax:
Practice Address - Street 1:6551 STAGE OAKS DR STE 4
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3895
Practice Address - Country:US
Practice Address - Phone:901-387-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-16
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000005118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional