MEDICARE: JIA MICHELLE LEBLANC M. ED., LPC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000000	OTHER	TX	NONE

General Provider Information

NPI Number	:	1669093555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIA MICHELLE LEBLANC M. ED., LPC

Provider Business Mailing Address
First Line	:	20351 HIGHWAY 6 STE B
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3882
Country	:	US
Telephone Number	:	979-557-2295
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 FM 517 RD W STE 215
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-3924
Country	:	US
Telephone Number	:	979-557-2295
Fax Number	:

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

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	07/04/2024

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