Provider Demographics
NPI:1770277469
Name:NELLE, JESSYCA COREY (LCMHC)
Entity type:Individual
Prefix:
First Name:JESSYCA
Middle Name:COREY
Last Name:NELLE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-0023
Mailing Address - Country:US
Mailing Address - Phone:802-585-4392
Mailing Address - Fax:
Practice Address - Street 1:518 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9375
Practice Address - Country:US
Practice Address - Phone:802-585-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0135277101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health