Provider Demographics
NPI:1659178192
Name:SCULL, JESSICA RYN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RYN
Last Name:SCULL
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RYN
Other - Last Name:YONGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5201 EVANS AVE APT D
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2148
Mailing Address - Country:US
Mailing Address - Phone:737-376-9972
Mailing Address - Fax:
Practice Address - Street 1:5201 EVANS AVE APT D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2148
Practice Address - Country:US
Practice Address - Phone:737-376-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX656431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical