Healthcare Provider Details

I. General information

NPI: 1326301839
Provider Name (Legal Business Name): JESSICA CISNEROS M.ED., LPC., BCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS JESSICA CHAPA

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 LILLIAN ST
HOUSTON TX
77007-5544
US

IV. Provider business mailing address

4625 LILLIAN ST
HOUSTON TX
77007-5544
US

V. Phone/Fax

Practice location:
  • Phone: 713-861-4849
  • Fax:
Mailing address:
  • Phone: 713-861-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65239
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: