Provider Demographics
NPI:1801548581
Name:MANCILLAS-FLORES, JESSICA MELISSA (LPC-ASSCOCIATE)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MELISSA
Last Name:MANCILLAS-FLORES
Suffix:
Gender:F
Credentials:LPC-ASSCOCIATE
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC-ASSOCIATE
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-0564
Mailing Address - Country:US
Mailing Address - Phone:210-334-1245
Mailing Address - Fax:
Practice Address - Street 1:5505 GRISSOM RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3024
Practice Address - Country:US
Practice Address - Phone:210-680-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health