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General NPI Number Information
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NPI Number | 1033046065
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Entity Type | Individual
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Provider Name | JERRICA NICOLE MAXEY
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Gender | Female
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Dates
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Enumeration Date | 05/05/2026
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Last Update Date | 05/05/2026
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Provider Practice Location Address
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Address Line | 705 E MARSHALL AVE STE 5003
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City | LONGVIEW
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State | TX
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Zip | 75601-5530
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Country | US
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Telephone | 903-470-7117
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Fax |
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Provider Business Mailing Address
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Address Line | 419 MARGIE BUSH RD
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City | HALLSVILLE
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State | TX
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Zip | 75650-7701
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Country | US
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Telephone | 903-452-0340
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Fax |
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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 | 98406
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License Number State | TX
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