Provider Demographics
NPI:1891406054
Name:ENGELS, JESSICA A (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:ENGELS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3034
Mailing Address - Country:US
Mailing Address - Phone:602-615-5797
Mailing Address - Fax:
Practice Address - Street 1:3707 E SOUTHERN AVE STE 2088
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6220
Practice Address - Country:US
Practice Address - Phone:480-509-7738
Practice Address - Fax:480-856-9069
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20402101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional