Provider Demographics
NPI:1013754050
Name:CUELLAR, JESSICA LEA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEA
Last Name:CUELLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:ZIERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 CARE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-5054
Mailing Address - Country:US
Mailing Address - Phone:517-439-2658
Mailing Address - Fax:
Practice Address - Street 1:25 CARE DRIVE
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-5054
Practice Address - Country:US
Practice Address - Phone:517-439-2658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6451023720101YM0800X
101YP2500X
MI6451023720101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional