Provider Demographics
NPI:1770187478
Name:JESSICA LOCUSON LCSW PLLC
Entity Type:Organization
Organization Name:JESSICA LOCUSON LCSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-844-0112
Mailing Address - Street 1:15250 QUORUM DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4611
Mailing Address - Country:US
Mailing Address - Phone:469-844-0112
Mailing Address - Fax:
Practice Address - Street 1:15250 QUORUM DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4611
Practice Address - Country:US
Practice Address - Phone:469-844-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty