MEDICARE: MS. JESSICA GIDEON WEST 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	17454	TX

General Provider Information

NPI Number	:	1881733343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA GIDEON WEST LPC

Provider Business Mailing Address
First Line	:	27 WINTER WHEAT PL
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-4351
Country	:	US
Telephone Number	:	832-725-6646
Fax Number	:	281-292-4018

Provider Business Practice Location Address
First Line	:	1600 LAKE FRONT CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3613
Country	:	US
Telephone Number	:	832-725-6646
Fax Number	:	281-292-4018

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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