Provider Demographics
NPI:1477137719
Name:THEISS, JAIME (LMFT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:THEISS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 HUDSON XING STE 1
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6556
Mailing Address - Country:US
Mailing Address - Phone:469-252-7090
Mailing Address - Fax:469-617-7052
Practice Address - Street 1:3128 HUDSON XING STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6556
Practice Address - Country:US
Practice Address - Phone:469-252-7090
Practice Address - Fax:469-617-7052
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202044101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor