Provider Demographics
NPI:1790064145
Name:KATZ, JESSICA E (MS, LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:E
Last Name:KATZ
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:E
Other - Last Name:THEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:1217 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3430
Mailing Address - Country:US
Mailing Address - Phone:321-458-5663
Mailing Address - Fax:
Practice Address - Street 1:851 WERNER CT STE 150
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1330
Practice Address - Country:US
Practice Address - Phone:307-222-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH8991101YM0800X
WYLPC1805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health