Provider Demographics
NPI:1417558966
Name:LEE, JESSYCA (RBT)
Entity Type:Individual
Prefix:
First Name:JESSYCA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17170 MILL FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4305
Mailing Address - Country:US
Mailing Address - Phone:832-240-4563
Mailing Address - Fax:
Practice Address - Street 1:17170 MILL FOREST RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4305
Practice Address - Country:US
Practice Address - Phone:832-240-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20142781106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician