Provider Demographics
NPI:1023746849
Name:JESKO, DEREK ROYCE (LPC)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:ROYCE
Last Name:JESKO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 W REYNOSA AVE
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1630
Mailing Address - Country:US
Mailing Address - Phone:254-893-5895
Mailing Address - Fax:888-895-1214
Practice Address - Street 1:2100 CROCKETT DR.
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5918
Practice Address - Country:US
Practice Address - Phone:325-646-0704
Practice Address - Fax:888-895-1214
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid