Provider Demographics
NPI:1184449035
Name:JORGENSEN, ELESA JO (MA, LMFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ELESA
Middle Name:JO
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MA, LMFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 DE FORTUNA DR
Mailing Address - Street 2:
Mailing Address - City:BEE CAVES
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6075
Mailing Address - Country:US
Mailing Address - Phone:307-231-0567
Mailing Address - Fax:
Practice Address - Street 1:1301 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6574
Practice Address - Country:US
Practice Address - Phone:512-814-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist