Healthcare Provider Details

I. General information

NPI: 1407782279
Provider Name (Legal Business Name): JESSICA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 LARIAT DR
DENISON TX
75021-4199
US

IV. Provider business mailing address

561 LARIAT DR
DENISON TX
75021-4199
US

V. Phone/Fax

Practice location:
  • Phone: 702-581-8962
  • Fax:
Mailing address:
  • Phone: 702-581-8962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: