Provider Demographics
NPI:1740855816
Name:SAN MIGUEL, JESSICA MARIE (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:SAN MIGUEL
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 IVY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6635
Mailing Address - Country:US
Mailing Address - Phone:956-833-1765
Mailing Address - Fax:
Practice Address - Street 1:3517 IVY AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6635
Practice Address - Country:US
Practice Address - Phone:956-833-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96507101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor