Provider Demographics
NPI:1194422170
Name:SOSA, JESSICA (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SOSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:OAKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BOYS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:79010-0066
Mailing Address - Country:US
Mailing Address - Phone:713-398-1312
Mailing Address - Fax:
Practice Address - Street 1:1400 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1708
Practice Address - Country:US
Practice Address - Phone:806-414-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical