Provider Demographics
NPI:1811377070
Name:CAVIN, JESSICA ANNE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:CAVIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:ANNE
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12450 FM 470
Mailing Address - Street 2:
Mailing Address - City:TARPLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78883-4403
Mailing Address - Country:US
Mailing Address - Phone:830-632-2502
Mailing Address - Fax:888-977-3018
Practice Address - Street 1:12450 FM 470
Practice Address - Street 2:
Practice Address - City:TARPLEY
Practice Address - State:TX
Practice Address - Zip Code:78883-4403
Practice Address - Country:US
Practice Address - Phone:830-632-2502
Practice Address - Fax:888-977-3018
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70400101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3476327-01Medicaid