Provider Demographics
NPI:1457781767
Name:BACON, JESSICA ROSE OGNIAN (LPC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE OGNIAN
Last Name:BACON
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 1:5819 PHEASANT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4202
Mailing Address - Country:US
Mailing Address - Phone:248-943-5627
Mailing Address - Fax:
Practice Address - Street 1:SEARCH HOMELESS SERVICES
Practice Address - Street 2:2015 CONGRESS
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002
Practice Address - Country:US
Practice Address - Phone:713-739-7752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool