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General NPI Number Information
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NPI Number | 1023256583
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Entity Type | Individual
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Provider Name | JESSICA JEAN DEROCHE M.ED.
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Gender | Female
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 571 S EDMONDS LN STE 102
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City | LEWISVILLE
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State | TX
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Zip | 75067-3645
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Country | US
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Telephone | 972-436-3118
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Fax | 972-453-4259
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Provider Business Mailing Address
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Address Line | 571 S EDMONDS LN STE 102
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City | LEWISVILLE
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State | TX
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Zip | 75067-3645
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Country | US
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Telephone | 972-436-3118
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Fax | 972-453-4259
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 61440
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License Number State | TX
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