Provider Demographics
NPI:1508562513
Name:UTLEY, JESSICA LYNNE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:UTLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W GREEN OAKS BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2789
Mailing Address - Country:US
Mailing Address - Phone:817-721-7426
Mailing Address - Fax:817-687-7012
Practice Address - Street 1:1026 COUNTY ROAD 544
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:TX
Practice Address - Zip Code:75173-8478
Practice Address - Country:US
Practice Address - Phone:817-721-7426
Practice Address - Fax:817-687-7012
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38033688OtherTEXAS DRIVERS LICENSE