Provider Demographics
NPI:1568954170
Name:RICH, JESSYCA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSYCA
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MS
Other - First Name:JESSYCA
Other - Middle Name:
Other - Last Name:GOOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:107 KOONTZ AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLENDENIN
Mailing Address - State:WV
Mailing Address - Zip Code:25045-9581
Mailing Address - Country:US
Mailing Address - Phone:304-548-7272
Mailing Address - Fax:304-548-7149
Practice Address - Street 1:107 KOONTZ AVE STE 200
Practice Address - Street 2:
Practice Address - City:CLENDENIN
Practice Address - State:WV
Practice Address - Zip Code:25045-9581
Practice Address - Country:US
Practice Address - Phone:304-548-7272
Practice Address - Fax:304-548-7149
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health