MEDICARE: JESSICA LANSING LPC

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	19136	TX

General Provider Information

NPI Number	:	1578507836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LANSING LPC

Provider Business Mailing Address
First Line	:	3031 IH 10 W
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-5159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 S ZARZAMORA ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-5362
Country	:	US
Telephone Number	:	210-731-1300
Fax Number	:	210-738-8025

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/09/2007

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