Healthcare Provider Details

I. General information

NPI: 1083541445
Provider Name (Legal Business Name): JESSICA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 SUNSET BLVD
GAINESVILLE GA
30501-2727
US

IV. Provider business mailing address

14864 FISHTRAP RD APT 513
AUBREY TX
76227-7634
US

V. Phone/Fax

Practice location:
  • Phone: 972-624-9197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: