Provider Demographics
NPI:1881143162
Name:SESSOMS, JEREMY MATTHEW (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MATTHEW
Last Name:SESSOMS
Suffix:
Gender:M
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 PARKVIEW DR
Mailing Address - Street 2:312
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5824
Mailing Address - Country:US
Mailing Address - Phone:682-200-9978
Mailing Address - Fax:
Practice Address - Street 1:2501 PARKVIEW DR
Practice Address - Street 2:312
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5824
Practice Address - Country:US
Practice Address - Phone:682-200-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67605101YP2500X
TX201656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist