MEDICARE: MS. JESSICA ANN AYALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	95584	TX

General Provider Information

NPI Number	:	1154150589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA ANN AYALA

Provider Business Mailing Address
First Line	:	24326 COURTLAND OAKS ST
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0276
Country	:	US
Telephone Number	:	281-785-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	5502 4TH ST
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77493-2427
Country	:	US
Telephone Number	:	832-463-3711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2024
Last Update Date	:	08/01/2024

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