Provider Demographics
NPI:1639680689
Name:WALDEN-GLASS, JESSICA (LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WALDEN-GLASS
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LCDC
Mailing Address - Street 1:9800 CENTRE PKWY STE 652
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8477
Mailing Address - Country:US
Mailing Address - Phone:832-757-5856
Mailing Address - Fax:888-607-8961
Practice Address - Street 1:800 BONAVENTURE WAY STE 116
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8005
Practice Address - Country:US
Practice Address - Phone:832-757-5856
Practice Address - Fax:888-607-8961
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YA0400X
TX77988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX394625301Medicaid