Provider Demographics
NPI:1669093555
Name:LEBLANC, JIA MICHELLE (M ED, LPC)
Entity type:Individual
Prefix:
First Name:JIA
Middle Name:MICHELLE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20351 HIGHWAY 6 STE B
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3882
Mailing Address - Country:US
Mailing Address - Phone:979-557-2295
Mailing Address - Fax:
Practice Address - Street 1:914 FM 517 RD W STE 215
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3924
Practice Address - Country:US
Practice Address - Phone:979-557-2295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000000000OtherNONE