MEDICARE: JESSICA E GARDEA

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	101YP2500X	Professional Counselor	90540	TX

General Provider Information

NPI Number	:	1356283709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA E GARDEA

Provider Business Mailing Address
First Line	:	5025 BAYBERRY DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3479
Country	:	US
Telephone Number	:	920-229-6192
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 BAYBERRY DR
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-3479
Country	:	US
Telephone Number	:	920-229-6192
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ JESSICA E GARDEA ” Practice Location

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