MEDICARE: MS. JESSICA ANN VINES-RITCHEY L.P.C., C.R.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19129	TX
2	101YP2500X	Professional Counselor	19129	TX

General Provider Information

NPI Number	:	1124265145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA ANN VINES-RITCHEY L.P.C., C.R.C.

Provider Business Mailing Address
First Line	:	13121 LOUETTA RD
Second Line	:	PMB 915
City	:	CYPRESS
State	:	TX
Zip	:	77429
Country	:	US
Telephone Number	:	281-857-6733
Fax Number	:	281-251-0705

Provider Business Practice Location Address
First Line	:	111 HOUSTON ST
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4759
Country	:	US
Telephone Number	:	281-255-9922
Fax Number	:	281-255-9922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	01/13/2009

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