Provider Demographics
NPI:1598263378
Name:THOMAS, JESSICA RAE (LPC, CI)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC, CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5010
Mailing Address - Country:US
Mailing Address - Phone:915-782-4023
Mailing Address - Fax:
Practice Address - Street 1:1626 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5010
Practice Address - Country:US
Practice Address - Phone:915-782-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health