Provider Demographics
NPI:1659855922
Name:SHERIDAN, JESSICA (MED, LBCBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:MED, LBCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 BLANCO DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5685
Mailing Address - Country:US
Mailing Address - Phone:602-680-8635
Mailing Address - Fax:
Practice Address - Street 1:915 W EXCHANGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7018
Practice Address - Country:US
Practice Address - Phone:214-547-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2252103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst