Healthcare Provider Details

I. General information

NPI: 1811433121
Provider Name (Legal Business Name): JESSICA LAUREN DAVIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 WOODHAVEN RD
JACKSON MS
39206-2528
US

IV. Provider business mailing address

6023 WOODHAVEN RD
JACKSON MS
39206-2528
US

V. Phone/Fax

Practice location:
  • Phone: 601-919-6603
  • Fax:
Mailing address:
  • Phone: 601-919-6603
  • Fax: 601-919-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2023-0182
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21937
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2609
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number91336
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8547
License Number StateLA
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number013846
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: