Healthcare Provider Details

I. General information

NPI: 1740855816
Provider Name (Legal Business Name): JESSICA MARIE SAN MIGUEL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 IVY AVE
MCALLEN TX
78501-6635
US

IV. Provider business mailing address

3517 IVY AVE
MCALLEN TX
78501-6635
US

V. Phone/Fax

Practice location:
  • Phone: 956-833-1765
  • Fax:
Mailing address:
  • Phone: 956-833-1765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96507
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number96507
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: