Provider Demographics
NPI:1154782415
Name:ESCOBEDO, JERRICA ELAYNE (LPC)
Entity type:Individual
Prefix:MS
First Name:JERRICA
Middle Name:ELAYNE
Last Name:ESCOBEDO
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 1:1501 WEST BEAUREGARD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4004
Mailing Address - Country:US
Mailing Address - Phone:325-658-7750
Mailing Address - Fax:325-658-8381
Practice Address - Street 1:424 SOUTH OAKES
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903
Practice Address - Country:US
Practice Address - Phone:325-658-7750
Practice Address - Fax:325-658-8381
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional