Provider Demographics
NPI:1326801648
Name:MOYA, JESSICA (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MOYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 PARK CPE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:TX
Mailing Address - Zip Code:78124-4081
Mailing Address - Country:US
Mailing Address - Phone:361-774-8070
Mailing Address - Fax:
Practice Address - Street 1:4835 PARK CPE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:TX
Practice Address - Zip Code:78124-4081
Practice Address - Country:US
Practice Address - Phone:361-774-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX654521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical