Provider Demographics
NPI:1104479518
Name:GLEATON, JEISHA (EDS)
Entity type:Individual
Prefix:MRS
First Name:JEISHA
Middle Name:
Last Name:GLEATON
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 DRAKE ELM DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4182
Mailing Address - Country:US
Mailing Address - Phone:904-487-2856
Mailing Address - Fax:
Practice Address - Street 1:1301 DRAKE ELM DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4182
Practice Address - Country:US
Practice Address - Phone:904-487-2856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70820103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool