Healthcare Provider Details

I. General information

NPI: 1962037390
Provider Name (Legal Business Name): ALEDRA MESHARN JACOBS LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 8TH ST
PORT ARTHUR TX
77640-6062
US

IV. Provider business mailing address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

V. Phone/Fax

Practice location:
  • Phone: 409-543-1381
  • Fax:
Mailing address:
  • Phone: 409-543-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number98438
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: