Provider Demographics
NPI:1073948089
Name:PHAM, JESSICA V (LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:V
Last Name:PHAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2324
Mailing Address - Country:US
Mailing Address - Phone:940-381-5000
Mailing Address - Fax:940-566-9072
Practice Address - Street 1:2519 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2324
Practice Address - Country:US
Practice Address - Phone:940-381-5000
Practice Address - Fax:940-566-9072
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94244101YM0800X
WAMC61028307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health