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General NPI Number Information
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NPI Number | 1386229714
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Entity Type | Individual
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Provider Name | JESSICA ANN APPLEGATE LCSW, LCDC
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Gender | Female
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Dates
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Enumeration Date | 03/17/2021
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Last Update Date | 03/17/2021
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Provider Practice Location Address
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Address Line | 560 N KIMBALL AVE STE 130
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6879
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Country | US
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Telephone | 817-488-0502
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Fax |
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Provider Business Mailing Address
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Address Line | 425 DONAGON CT
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City | HASLET
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State | TX
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Zip | 76052-5199
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Country | US
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Telephone | 817-676-6444
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 63303
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License Number State | TX
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