Provider Demographics
NPI:1659061638
Name:GILLILAND, JESSIE-ROSE (LPC)
Entity Type:Individual
Prefix:
First Name:JESSIE-ROSE
Middle Name:
Last Name:GILLILAND
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 1:5246 SUNSHINE PT
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-9154
Mailing Address - Country:US
Mailing Address - Phone:832-641-0759
Mailing Address - Fax:
Practice Address - Street 1:2500 LONE STAR PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-7709
Practice Address - Country:US
Practice Address - Phone:936-529-1416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health