Provider Demographics
NPI:1841587110
Name:CALLAHAN, JESSICA (LPC-S)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 N COLLINS BLVD
Mailing Address - Street 2:STE 190
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3566
Mailing Address - Country:US
Mailing Address - Phone:469-662-0607
Mailing Address - Fax:469-248-3635
Practice Address - Street 1:1755 N COLLINS BLVD
Practice Address - Street 2:STE 525
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3613
Practice Address - Country:US
Practice Address - Phone:214-369-5522
Practice Address - Fax:214-369-5327
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional