Provider Demographics
NPI:1205272648
Name:JESSIE, YALANDA S (MED LPC)
Entity type:Individual
Prefix:MRS
First Name:YALANDA
Middle Name:S
Last Name:JESSIE
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 FANNIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3948
Mailing Address - Country:US
Mailing Address - Phone:409-832-7771
Mailing Address - Fax:409-832-0022
Practice Address - Street 1:755 S 11TH ST STE 246
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701
Practice Address - Country:US
Practice Address - Phone:409-832-7771
Practice Address - Fax:409-832-0022
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67739101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3225252Medicaid