Provider Demographics
NPI:1801177100
Name:SUGAMELE, JESSICA LYNN (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SUGAMELE
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 1:2145 PARADISE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-7908
Mailing Address - Country:US
Mailing Address - Phone:512-436-8013
Mailing Address - Fax:
Practice Address - Street 1:2145 PARADISE RIDGE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-7908
Practice Address - Country:US
Practice Address - Phone:512-436-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68042101YM0800X
COLPC-6091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health