Provider Demographics
NPI:1477159275
Name:DAVID, JESSICA LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:DAVID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3229 HIGHWAY J
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65260-3205
Mailing Address - Country:US
Mailing Address - Phone:660-676-2955
Mailing Address - Fax:
Practice Address - Street 1:3229 HIGHWAY J
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65260-3205
Practice Address - Country:US
Practice Address - Phone:660-676-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016004606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional