Healthcare Provider Details

I. General information

NPI: 1780904938
Provider Name (Legal Business Name): JENNIFER L ESCAMILLA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 W JOSEPHINE ST
MCKINNEY TX
75069-3124
US

IV. Provider business mailing address

1810 W JOSEPHINE ST
MCKINNEY TX
75069-3124
US

V. Phone/Fax

Practice location:
  • Phone: 214-437-9473
  • Fax:
Mailing address:
  • Phone: 214-437-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number64019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: