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General NPI Number Information
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NPI Number | 1174095376
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Entity Type | Individual
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Provider Name | JESSICA SKY SCHNEIDER-WATSON LPC-INTERN
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Gender | Female
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Dates
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Enumeration Date | 12/28/2018
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Last Update Date | 12/28/2018
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Provider Practice Location Address
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Address Line | 300 S MAIN ST STE 201
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City | WEATHERFORD
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State | TX
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Zip | 76086-4366
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Country | US
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Telephone | 817-771-3949
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Fax |
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Provider Business Mailing Address
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Address Line | 202 CROWN POINTE BLVD APT 1128
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City | WILLOW PARK
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State | TX
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Zip | 76087-1151
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Country | US
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Telephone | 817-771-3949
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 73124
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License Number State | TX
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