Provider Demographics
NPI:1598909582
Name:ACKER, JESSICA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:ACKER
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 1:1605 BEECH ST
Mailing Address - Street 2:STE A2
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1101
Mailing Address - Country:US
Mailing Address - Phone:915-549-5308
Mailing Address - Fax:915-881-8788
Practice Address - Street 1:1605 BEECH ST
Practice Address - Street 2:STE A2
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1101
Practice Address - Country:US
Practice Address - Phone:915-549-5308
Practice Address - Fax:915-881-8788
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201937404Medicaid
TX280611901Medicaid