Provider Demographics
NPI:1720395494
Name:JESSICA CALLICUTT COUNSELING LLC
Entity Type:Organization
Organization Name:JESSICA CALLICUTT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CALLICUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:214-728-6861
Mailing Address - Street 1:1755 N COLLINS BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3613
Mailing Address - Country:US
Mailing Address - Phone:214-369-5522
Mailing Address - Fax:214-369-5327
Practice Address - Street 1:1755 N COLLINS BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3613
Practice Address - Country:US
Practice Address - Phone:214-369-5522
Practice Address - Fax:214-369-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty