Healthcare Provider Details

I. General information

NPI: 1104631928
Provider Name (Legal Business Name): JESSICA MARIE CHAVEZ M.ED., LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 LONE STAR PKWY STE 303
SAN ANTONIO TX
78253-6722
US

IV. Provider business mailing address

5522 LONE STAR PKWY STE 303
SAN ANTONIO TX
78253-6722
US

V. Phone/Fax

Practice location:
  • Phone: 210-664-1275
  • Fax:
Mailing address:
  • Phone: 210-664-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: