Provider Demographics
NPI:1760074520
Name:GALLANT, JESSICA (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GALLANT
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 1:813 COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5061
Mailing Address - Country:US
Mailing Address - Phone:972-955-7145
Mailing Address - Fax:
Practice Address - Street 1:3600 ELDORADO PKWY STE 3
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-3793
Practice Address - Country:US
Practice Address - Phone:469-712-5848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80905101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80905OtherTBHEC LICENSE NUMBER