Provider Demographics
NPI:1619375037
Name:MOLBERG, JESSICA L (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MOLBERG
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 1:3103 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4535
Mailing Address - Country:US
Mailing Address - Phone:210-340-8077
Mailing Address - Fax:
Practice Address - Street 1:121 OLD SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3415
Practice Address - Country:US
Practice Address - Phone:830-816-2425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional