Provider Demographics
NPI:1659971455
Name:MITCHELL, JESSICA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 ELDORADO PKWY STE 227
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6198
Mailing Address - Country:US
Mailing Address - Phone:469-712-5481
Mailing Address - Fax:214-856-3375
Practice Address - Street 1:6401 ELDORADO PKWY STE 227
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6198
Practice Address - Country:US
Practice Address - Phone:469-712-5481
Practice Address - Fax:214-856-3375
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79335101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty