Provider Demographics
NPI:1285289223
Name:SEIDEL, JESSICA DAWN (LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAWN
Last Name:SEIDEL
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 1:1811 MARLENE DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4813
Mailing Address - Country:US
Mailing Address - Phone:972-765-6123
Mailing Address - Fax:
Practice Address - Street 1:1452 HUGHES RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9221
Practice Address - Country:US
Practice Address - Phone:682-738-6673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty