Provider Demographics
NPI:1427195072
Name:COULSON, JESSE EDWARD (EDD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:EDWARD
Last Name:COULSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-0817
Mailing Address - Country:US
Mailing Address - Phone:940-642-3087
Mailing Address - Fax:940-872-1018
Practice Address - Street 1:307 WEST TARRANT STREET, SUITE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-4102
Practice Address - Country:US
Practice Address - Phone:940-642-3087
Practice Address - Fax:940-872-1018
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health