Provider Demographics
NPI:1821688060
Name:PROCTOR, JEFFREY CHARLES (LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CHARLES
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BELLE GROVE DR UNIT 833251
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-4658
Mailing Address - Country:US
Mailing Address - Phone:940-290-3191
Mailing Address - Fax:
Practice Address - Street 1:2007 N COLLINS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2666
Practice Address - Country:US
Practice Address - Phone:469-930-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty