Provider Demographics
NPI:1578002143
Name:HORNAGE, JESSICA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HORNAGE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 SOJOURN DR
Mailing Address - Street 2:APT 2006
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5086
Mailing Address - Country:US
Mailing Address - Phone:318-730-2822
Mailing Address - Fax:
Practice Address - Street 1:2696 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6441
Practice Address - Country:US
Practice Address - Phone:318-730-2822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional