Provider Demographics
NPI:1295337277
Name:DEL RIO, JESSICA (LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DEL RIO
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 1:11282 TAYLOR DRAPER LN APT 315
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3957
Mailing Address - Country:US
Mailing Address - Phone:915-240-0703
Mailing Address - Fax:
Practice Address - Street 1:11282 TAYLOR DRAPER LN APT 315
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3957
Practice Address - Country:US
Practice Address - Phone:915-240-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional